Individual
DR. KARIN ANDREA PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O., PHD
Contact information
Practice address
1020 YOUNGS RD, WILLIAMSVILLE, NY 14221-2698
(716) 961-9900
(716) 961-9911
Mailing address
53 DEER RUN, ORCHARD PARK, NY 14127-3455
(716) 662-0606
(716) 862-8632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
249836-1
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
249836-1
NY
207RP1001X
Pulmonary Disease Physician
Primary
249836-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03030462
—
NY
Enumeration date
01/29/2007
Last updated
07/21/2022
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