Provider Demographics
NPI:1598700650
Name:KAWINSKI, BOHDAN JERZY (MD)
Entity Type:Individual
Prefix:
First Name:BOHDAN
Middle Name:JERZY
Last Name:KAWINSKI
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 1:3884 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1104
Mailing Address - Country:US
Mailing Address - Phone:716-681-9000
Mailing Address - Fax:716-256-1079
Practice Address - Street 1:3884 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1104
Practice Address - Country:US
Practice Address - Phone:716-681-9000
Practice Address - Fax:716-256-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010004541OtherRAILROAD MEDICARE
NY0406107OtherINDEPENDENT HEALTH
NY00010088701OtherUNIVERA
NY00722409Medicaid
NY000508655004OtherBLUE CROSS BLUE SHIELD WN
NYAA1196Medicare PIN
NY0406107OtherINDEPENDENT HEALTH