Provider Demographics
NPI:1003429234
Name:BAX MEDICAL PLLC
Entity Type:Organization
Organization Name:BAX MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-285-7366
Mailing Address - Street 1:825 ONONDAGA ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1422
Mailing Address - Country:US
Mailing Address - Phone:716-940-2555
Mailing Address - Fax:
Practice Address - Street 1:700 PARK PL
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1028
Practice Address - Country:US
Practice Address - Phone:716-285-7366
Practice Address - Fax:716-285-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty