1295796845 NPI number — KEVIN PRANIKOFF MD

Table of content: KEVIN PRANIKOFF MD (NPI 1295796845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295796845 NPI number — KEVIN PRANIKOFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRANIKOFF
Provider First Name:
KEVIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295796845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
462 GRIDER STREET
Provider Second Line Business Mailing Address:
SUITE 119
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-898-5008
Provider Business Mailing Address Fax Number:
716-898-4186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 GRIDER STREET
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-898-5008
Provider Business Practice Location Address Fax Number:
716-898-4186
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  124932 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00010140903 . This is a "BUFFALO COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00010140903 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "CB COMMUNITY CARE FAMILY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900822 . This is a "IHA ENCOMPASS 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010640 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "COMMUNITY BLUE ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00010140903 . This is a "UNIVERA CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00631434 . This is a "GOLD CHOICE MCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "COMMUNITY BLUE SENIOR BLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00631434 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1900822 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "BLUE CROSS BLUE SHIELD WN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900822 . This is a "IHA MEDISOURCE" identifier . This identifiers is of the category "OTHER".




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