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NPI Code Detail

MEDICARE: DR. KARIN ANDREA PROVOST D.O., PHD

MEDICARE: DR. KARIN ANDREA PROVOST D.O., PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician249836-1NY
2207RC0200XCritical Care Medicine (Internal Medicine) Physician249836-1NY
3207RP1001XPulmonary Disease Physician249836-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164568374
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KARIN ANDREA PROVOST D.O., PHD
Provider Business Mailing Address
First Line : 53 DEER RUN
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-3455
Country : US
Telephone Number : 716-662-0606
Fax Number : 716-862-8632
Provider Business Practice Location Address
First Line : 1020 YOUNGS RD
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-2698
Country : US
Telephone Number : 716-961-9900
Fax Number : 716-961-9911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 07/21/2022

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