Provider Demographics
NPI:1619256021
Name:KODA, EMI A (DO)
Entity Type:Individual
Prefix:
First Name:EMI
Middle Name:A
Last Name:KODA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 SOUTHWESTERN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-972-0279
Mailing Address - Fax:716-972-0273
Practice Address - Street 1:3675 SOUTHWESTERN BOULEVARD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-972-0279
Practice Address - Fax:360-493-5524
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine