Healthcare Provider Details

I. General information

NPI: 1982679312
Provider Name (Legal Business Name): KENNETH KRACKOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST UNIVERSITY ORTHOPAEDIC SERVICES
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

100 HIGH ST UNIVERSITY ORTHOPAEDIC SERVICES
BUFFALO NY
14203-1126
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-1256
  • Fax:
Mailing address:
  • Phone: 716-859-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number190562
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: