Provider Demographics
NPI:1255595138
Name:SUTEH KPAJOH, KURTIS KIADUM (DMSC, PA)
Entity type:Individual
Prefix:DR
First Name:KURTIS KIADUM
Middle Name:
Last Name:SUTEH KPAJOH
Suffix:
Gender:M
Credentials:DMSC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4703
Mailing Address - Country:US
Mailing Address - Phone:716-541-0550
Mailing Address - Fax:315-741-0779
Practice Address - Street 1:3921 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4703
Practice Address - Country:US
Practice Address - Phone:716-541-0550
Practice Address - Fax:315-741-0779
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400089155OtherMEDICARE PTAN
NY03047683Medicaid