MEDICARE: ELIZABETH L KYGER 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	207Q00000X	Family Medicine Physician	143470	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040426002785	OTHER	NY	FIDELIS
2	000508584005	OTHER		BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000508584004	OTHER	NY	BC/BS
5	151096BF	OTHER	NY	PREFERRED CARE
6	0109801	OTHER	NY	IHA
7	00010097403	OTHER	NY	UNIVERA
8	00010097404	OTHER		UNIVERA

General Provider Information

NPI Number	:	1548241177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH L KYGER M.D.

Provider Business Mailing Address
First Line	:	2875 UNION RD
Second Line	:	SUITE 8
City	:	CHEEKTOWAGA
State	:	NY
Zip	:	14227-1465
Country	:	US
Telephone Number	:	716-651-0911
Fax Number	:	716-651-9855

Provider Business Practice Location Address
First Line	:	64 HAGER ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14208-1327
Country	:	US
Telephone Number	:	716-886-4377
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/21/2014

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