Individual
MARK R KLOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6000 N BAILEY AVE, AMHERST, NY 14226-5102
(716) 834-4522
(716) 834-6191
Mailing address
6000 N BAILEY AVE, AMHERST, NY 14226-5102
(716) 834-4522
(716) 834-6191
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
182253
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010092105
UNIVERA
NY
01
—
000511134005
BC/BS
NY
05
—
01245578
—
NY
01
—
040426001490
FIDELIS
NY
01
—
1208952
IHA
NY
01
—
143849DL
PREFERRED CARE
NY
Enumeration date
10/24/2005
Last updated
07/21/2014
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