MEDICARE: DR. KISHOR V PHADKE M.D.

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
1	207RI0011X	Interventional Cardiology Physician	197824	NY
2	207RC0000X	Cardiovascular Disease Physician	197824	NY

General Provider Information

NPI Number	:	1205840162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KISHOR V PHADKE M.D.

Provider Business Mailing Address
First Line	:	726 EXCHANGE ST
Second Line	:	SUITE 516
City	:	BUFFALO
State	:	NY
Zip	:	14210-1484
Country	:	US
Telephone Number	:	716-852-4772
Fax Number	:	716-842-3190

Provider Business Practice Location Address
First Line	:	705 MAPLE RD STE 300
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-3291
Country	:	US
Telephone Number	:	716-710-8266
Fax Number	:	716-710-8267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	10/14/2020

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