Provider Demographics
NPI:1629179486
Name:K SUH MD PC
Entity Type:Organization
Organization Name:K SUH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-4798
Mailing Address - Street 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:338 HARRIS HILL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7407
Practice Address - Country:US
Practice Address - Phone:716-634-4798
Practice Address - Fax:716-634-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112773-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000504465002OtherBLUE CROSS
NY00587444Medicaid
NY2708505OtherINDEPENDENT HEALTH
NY2708505OtherINDEPENDENT HEALTH
NYAA1363Medicare ID - Type Unspecified