Organization
GREAT LAKES PHYSICIAN, PC
Active
Other names
Western New York Urology Associates LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KAIRAV KENT CHEVLI MD (MANAGING PHYSICIAN)
(716) 844-5000
Entity
Organization
Contact information
Practice address
3085 HARLEM RD, SUITE 350, CHEEKTOWAGA, NY 14225-2591
(716) 844-5000
(716) 844-5050
Mailing address
3085 HARLEM RD, SUITE 350, CHEEKTOWAGA, NY 14225-2591
(716) 844-5000
(716) 844-5050
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03869087
—
NY
Enumeration date
06/04/2006
Last updated
06/07/2022
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