Provider Demographics
NPI:1023063955
Name:MIDLER, KAY ELIZABETH (DO)
Entity type:Individual
Prefix:MRS
First Name:KAY
Middle Name:ELIZABETH
Last Name:MIDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:KAY
Other - Middle Name:ELIZABETH
Other - Last Name:LADERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1050 RIVER OAKS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9564
Mailing Address - Country:US
Mailing Address - Phone:601-420-0265
Mailing Address - Fax:601-709-2452
Practice Address - Street 1:1050 RIVER OAKS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-200-8201
Practice Address - Fax:601-987-0019
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21122207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00452051Medicaid
GA329677218AMedicaid
I40257Medicare UPIN
16BBCVZMedicare PIN
GA329677218AMedicaid