Provider Demographics
NPI:1497846042
Name:KAY, DICKIE (MD)
Entity Type:Individual
Prefix:
First Name:DICKIE
Middle Name:
Last Name:KAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N NORTHWEST HWY STE 170
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-6402
Mailing Address - Country:US
Mailing Address - Phone:847-692-7101
Mailing Address - Fax:847-692-7126
Practice Address - Street 1:444 N NORTHWEST HWY STE 170
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-6402
Practice Address - Country:US
Practice Address - Phone:847-692-7101
Practice Address - Fax:847-692-7126
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001615772OtherBLUE CROSS/BLUE SHIELD
IL0001615772OtherBLUE CROSS/BLUE SHIELD
ILD15490Medicare UPIN