Basic Information
| Provider Information | |||||||||
| NPI: | 1134506702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KPANDEYENGE | ||||||||
| FirstName: | TITY | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 BARTON ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142131573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168816191 | ||||||||
| FaxNumber: | 7168816247 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 BARTON ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163483000 | ||||||||
| FaxNumber: | 7168816247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2015 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT216140 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 299099 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.