Healthcare Provider Details

I. General information

NPI: 1154980266
Provider Name (Legal Business Name): MOHAMAD KARIM KECHLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST STE K-3502
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST STE K-3502
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-6659
  • Fax:
Mailing address:
  • Phone: 716-323-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP11348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: