Provider Demographics
NPI:1124195649
Name:ZULKHARNAIN, UNKNOWN (MD)
Entity Type:Individual
Prefix:DR
First Name:UNKNOWN
Middle Name:
Last Name:ZULKHARNAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SOBIESKI ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212
Mailing Address - Country:US
Mailing Address - Phone:716-649-0887
Mailing Address - Fax:716-646-4611
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:KENMORE MERCY HOSPITAL
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-447-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01614204Medicaid
NY0409228OtherIHA
NY00010195106OtherUNIVERA
NY000523687009OtherWNY BCBS
NY01614204Medicaid
NY00010195106OtherUNIVERA
NY000523687009OtherWNY BCBS