Provider Demographics
NPI:1295715514
Name:DONOVAN-ANTALEK, KATHLEEN M (DO)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:DONOVAN-ANTALEK
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CORPORATE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1263
Mailing Address - Country:US
Mailing Address - Phone:716-631-0380
Mailing Address - Fax:716-631-3229
Practice Address - Street 1:500 CORPORATE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1263
Practice Address - Country:US
Practice Address - Phone:716-631-0380
Practice Address - Fax:716-631-3229
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170207207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01091941Medicaid
NYF50935Medicare UPIN