Basic Information
| Provider Information | |||||||||
| NPI: | 1154610830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAWALE | ||||||||
| FirstName: | KUNAL | ||||||||
| MiddleName: | BHALCHANDRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 PRESIDENTIAL PLZ | ||||||||
| Address2: | APT 601 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132022229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153950106 | ||||||||
| FaxNumber: | 3154647564 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | SUNY UPSTATE MEDICAL UNIVERSITY | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645800 | ||||||||
| FaxNumber: | 3154647564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ASO552489172 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.