Healthcare Provider Details

I. General information

NPI: 1801216858
Provider Name (Legal Business Name): KILEY BAX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK PL
NIAGARA FALLS NY
14301-1028
US

IV. Provider business mailing address

700 PARK PL
NIAGARA FALLS NY
14301-1028
US

V. Phone/Fax

Practice location:
  • Phone: 716-285-7366
  • Fax: 716-285-2580
Mailing address:
  • Phone: 171-628-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number28877101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: