Healthcare Provider Details

I. General information

NPI: 1619081122
Provider Name (Legal Business Name): KARL D KIEBURTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 WESTFALL RD BLDG C, SUITE 220
ROCHESTER NY
14618-2638
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 278984
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7500
  • Fax: 585-341-7510
Mailing address:
  • Phone: 585-341-7500
  • Fax: 585-341-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number164140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: