Provider Demographics
NPI:1154460830
Name:KAY ROBERTSON MD PC
Entity Type:Organization
Organization Name:KAY ROBERTSON MD PC
Other - Org Name:KAY ROBERTSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-858-9400
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5045
Mailing Address - Country:US
Mailing Address - Phone:248-858-9400
Mailing Address - Fax:248-858-9493
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-858-9400
Practice Address - Fax:248-858-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068781207R00000X
4301068781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01674Medicare UPIN
MIOP18950Medicare ID - Type Unspecified