Provider Demographics
NPI:1215934781
Name:CHEVLI, K KENT (MD)
Entity type:Individual
Prefix:DR
First Name:K
Middle Name:KENT
Last Name:CHEVLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KAIRAV
Other - Middle Name:DHANSUKH
Other - Last Name:CHEVLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3085 HARLEM RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2563
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:3085 HARLEM RD
Practice Address - Street 2:STE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2563
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195675208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000523274005OtherBCBS OF WNY
NY01482255Medicaid
NY195675-4OtherWORKERS COMP
NY040426000815OtherFIDELIS
NY1909181OtherINDEPENDENT HEALTH
NY1000375OtherGHI
NY00010029501OtherUNIVERA
NY195675-4OtherWORKERS COMP
NY040426000815OtherFIDELIS
NY14359BMedicare ID - Type Unspecified