Provider Demographics
NPI:1801216858
Name:BAX, KILEY (MD)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:BAX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1028
Mailing Address - Country:US
Mailing Address - Phone:171-628-5736
Mailing Address - Fax:
Practice Address - Street 1:700 PARK PL
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1028
Practice Address - Country:US
Practice Address - Phone:716-285-7366
Practice Address - Fax:716-285-2580
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28877101207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty