Provider Demographics
NPI:1578608899
Name:TAY, MICHAEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:TAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4820 BUCKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0961
Mailing Address - Country:US
Mailing Address - Phone:775-827-9141
Mailing Address - Fax:786-513-6333
Practice Address - Street 1:4820 BUCKHAVEN RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0961
Practice Address - Country:US
Practice Address - Phone:775-827-9141
Practice Address - Fax:786-513-6333
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV116562085R0001X
MI43010312052085R0001X
ALMD.277082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-3121224Medicaid
MI10-3121224Medicaid
A74340Medicare UPIN