Provider Demographics
NPI:1760402010
Name:KAYE, MITCHELL G (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:G
Last Name:KAYE
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 1:4570 W 77TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5038
Mailing Address - Country:US
Mailing Address - Phone:952-567-7400
Mailing Address - Fax:
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:952-852-5338
Practice Address - Fax:612-863-9252
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32664207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN290000116OtherPROVIDER TRANSACTION ACCESS NUMBER
MN290003255OtherRAILROAD MEDICARE
MN290000116OtherPROVIDER TRANSACTION ACCESS NUMBER