Healthcare Provider Details

I. General information

NPI: 1003429234
Provider Name (Legal Business Name): BAX MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK PL
NIAGARA FALLS NY
14301-1028
US

IV. Provider business mailing address

825 ONONDAGA ST
LEWISTON NY
14092-1422
US

V. Phone/Fax

Practice location:
  • Phone: 716-285-7366
  • Fax: 716-285-2580
Mailing address:
  • Phone: 716-940-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KILEY BAX
Title or Position: OWNER
Credential: MD
Phone: 716-285-7366