Provider Demographics
NPI:1578521811
Name:GYVES-RAY, KATHERINE MARY (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:GYVES-RAY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3695 GREEN RD
Mailing Address - Street 2:UNIT 22778
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7939
Mailing Address - Country:US
Mailing Address - Phone:330-655-1874
Mailing Address - Fax:866-461-7993
Practice Address - Street 1:5655 HUDSON DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4451
Practice Address - Country:US
Practice Address - Phone:330-655-1874
Practice Address - Fax:866-461-7993
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1056702085P0229X
CT0514832085R0202X
IL036-1239772085R0202X
CODR.00487672085P0229X
KY420982085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209798214Medicaid
KY7100068710Medicaid
2698331Medicare ID - Type Unspecified