Provider Demographics
NPI:1598782146
Name:KULAYLAT, MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:KULAYLAT
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:PO BOX 8000 DEPT 313
Mailing Address - Street 2:UNIVERSITY AT BUFFALO SURGEONS, INC
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-888-4889
Mailing Address - Fax:716-849-5620
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:BUFFALO GENERAL HOSPITAL, DEPT OF SURGERY
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-2050
Practice Address - Fax:716-859-4580
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176682208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01192589Medicaid
NY01192589Medicaid
NYDD2317Medicare ID - Type UnspecifiedMEDICARE