Healthcare Provider Details

I. General information

NPI: 1518949379
Provider Name (Legal Business Name): ALFREDO KUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 WEHRLE DR
WILLIAMSVILLE NY
14221-7332
US

IV. Provider business mailing address

PO BOX 1848
BUFFALO NY
14240-1848
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-3700
  • Fax:
Mailing address:
  • Phone: 716-923-4385
  • Fax: 716-246-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number205990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: