Provider Demographics
NPI:1104868371
Name:KING, RAY H (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:H
Last Name:KING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0002
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:400 HINCKLEY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-6125
Practice Address - Country:US
Practice Address - Phone:517-784-0588
Practice Address - Fax:517-784-3866
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00402205OtherRR MEDICARE
MI080083111OtherRAILROAD MEDICARE
MI105190507Medicaid
5340399OtherCIGNA
5464083OtherAETNA USHEALTHCARE
5464083OtherAETNA USHEALTHCARE
5340399OtherCIGNA