MEDICARE: MRS. KATHLEEN E SCHIELE PHYSICIAN ASSISTANT

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	002368-1	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00026556202	OTHER		UNIVERA
3	141534BF	OTHER	NY	PREFERRED CARE
4	9511805	OTHER	NY	INDEPENDENT HEALTH
5	000570020004	OTHER	NY	BC/BS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1407850886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN E SCHIELE PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	4855 CAMP RD
Second Line	:	SUITE 100
City	:	HAMBURG
State	:	NY
Zip	:	14075-2600
Country	:	US
Telephone Number	:	716-646-1084
Fax Number	:	716-646-0763

Provider Business Practice Location Address
First Line	:	4855 CAMP RD
Second Line	:	SUITE 100
City	:	HAMBURG
State	:	NY
Zip	:	14075-2600
Country	:	US
Telephone Number	:	716-646-1084
Fax Number	:	716-646-0763

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/12/2014

4855 CAMP RD STE 400
HAMBURG, NY
14075-2600

Practice Phone: 716-648-6875
Practice Fax: 716-648-6939

4855 CAMP RD , SUITE 100
HAMBURG, NY
14075-2600