Provider Demographics
NPI:1023112018
Name:BHANGOO, KULWANT SINGH (MD)
Entity type:Individual
Prefix:
First Name:KULWANT
Middle Name:SINGH
Last Name:BHANGOO
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 1:4 CAZENOVIA STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1794
Mailing Address - Country:US
Mailing Address - Phone:716-826-4800
Mailing Address - Fax:716-826-5643
Practice Address - Street 1:4 CAZENOVIA STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1794
Practice Address - Country:US
Practice Address - Phone:716-826-4800
Practice Address - Fax:716-826-5643
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120905208200000X
DC7369208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1371533Medicare UPIN
065703Medicare ID - Type Unspecified