Healthcare Provider Details

I. General information

NPI: 1306923347
Provider Name (Legal Business Name): KAILASH PRASAD SAXENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRYNSTONE CT
AMHERST NY
14228-3703
US

IV. Provider business mailing address

36 BRYNSTONE CT
AMHERST NY
14228-3703
US

V. Phone/Fax

Practice location:
  • Phone: 716-361-1053
  • Fax: 716-691-9575
Mailing address:
  • Phone: 716-361-1053
  • Fax: 716-691-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number137646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: