Healthcare Provider Details

I. General information

NPI: 1649899956
Provider Name (Legal Business Name): HENRY KLOS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 MAIN ST STE 301
BUFFALO NY
14209-2398
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-2644
  • Fax:
Mailing address:
  • Phone: 716-898-3941
  • Fax: 716-898-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number343169
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: