Basic Information
| Provider Information | |||||||||
| NPI: | 1760402010 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAYE | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4570 W 77TH ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554355038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525677400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 E 28TH ST | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528525338 | ||||||||
| FaxNumber: | 6128639252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 32664 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 290000116 | 01 | MN | PROVIDER TRANSACTION ACCESS NUMBER | OTHER | 290003255 | 01 | MN | RAILROAD MEDICARE | OTHER |