Provider Demographics
NPI:1679668305
Name:DIAKUN, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:DIAKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2121 MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2693
Mailing Address - Country:US
Mailing Address - Phone:716-836-7510
Mailing Address - Fax:716-836-7511
Practice Address - Street 1:2121 MAIN STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-836-7510
Practice Address - Fax:716-836-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY169375-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01042722Medicaid
NY01042722Medicaid
NYF56227Medicare UPIN