Healthcare Provider Details

I. General information

NPI: 1003884289
Provider Name (Legal Business Name): TIMOTHY MICHAEL KITCHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 E MAIN ST
WESTFIELD NY
14787-1121
US

IV. Provider business mailing address

138 E MAIN ST PO BOX 10
WESTFIELD NY
14787-1121
US

V. Phone/Fax

Practice location:
  • Phone: 716-326-4678
  • Fax: 716-326-4914
Mailing address:
  • Phone: 716-326-4678
  • Fax: 716-326-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number188164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: