Individual
DR. KATHLEEN T. GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3560 N BUFFALO ST, ORCHARD PARK, NY 14127-1934
(716) 662-8510
(716) 662-8574
Mailing address
3560 N BUFFALO ST, ORCHARD PARK, NY 14127-1934
(716) 662-8510
(716) 662-8574
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
198122
NY
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
198122
NY
208000000X
Pediatrics Physician
198122
NY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
198122
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010298401
UNIVERA
NY
01
—
00010298402
UNIVERA
—
01
—
000524676001
BC/BS OF WNY
NY
01
—
000524676003
BC/BS
—
01
—
000524676004
BC/BS
—
01
—
000524676005
BC/BS
—
05
—
01744283
—
NY
01
—
0409065
IHA
—
01
—
05092300013
FIDELIS
—
01
—
051213000027
FIDELIS
—
01
—
080515000099
FIDELIS
—
Enumeration date
04/14/2006
Last updated
01/07/2016
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