Provider Demographics
NPI:1295796845
Name:PRANIKOFF, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:PRANIKOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:462 GRIDER STREET
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215
Mailing Address - Country:US
Mailing Address - Phone:716-898-5008
Mailing Address - Fax:716-898-4186
Practice Address - Street 1:462 GRIDER STREET
Practice Address - Street 2:SUITE 119
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-898-5008
Practice Address - Fax:716-898-4186
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-06-18
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Provider Licenses
StateLicense IDTaxonomies
NY124932208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010140903OtherBUFFALO COMMUNITY HEALTH
00010140903OtherUNIVERA
000507827003OtherCB COMMUNITY CARE FAMILY
1900822OtherIHA ENCOMPASS 65
0010640OtherGHI
000507827003OtherCOMMUNITY BLUE ADVANTAGE
00010140903OtherUNIVERA CHOICE CARE
00631434OtherGOLD CHOICE MCD
000507827003OtherCOMMUNITY BLUE
000507827003OtherCOMMUNITY BLUE SENIOR BLU
NY00631434Medicaid
1900822OtherINDEPENDENT HEALTH
000507827003OtherBLUE CROSS BLUE SHIELD WN
1900822OtherIHA MEDISOURCE
1900822OtherIHA ENCOMPASS 65
00010140903OtherBUFFALO COMMUNITY HEALTH
00631434OtherGOLD CHOICE MCD
000507827003OtherCOMMUNITY BLUE ADVANTAGE