Provider Demographics
NPI:1255395323
Name:KAY, BRENT W (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:W
Last Name:KAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 N MAYFAIR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2252
Mailing Address - Country:US
Mailing Address - Phone:800-318-0019
Mailing Address - Fax:414-607-3948
Practice Address - Street 1:27450 YNEZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4680
Practice Address - Country:US
Practice Address - Phone:714-935-0073
Practice Address - Fax:714-935-0075
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG75232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF80992Medicare UPIN
00G752320Medicare PIN