Provider Demographics
NPI:1811143639
Name:POPPENBERG DUQUETTE, KRISTIN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:POPPENBERG DUQUETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3560 N BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1934
Mailing Address - Country:US
Mailing Address - Phone:716-662-8510
Mailing Address - Fax:716-662-8574
Practice Address - Street 1:3560 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1934
Practice Address - Country:US
Practice Address - Phone:716-662-8510
Practice Address - Fax:716-662-8574
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY251812208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03112856Medicaid
NYJ400004109Medicare PIN
NY1811143639Medicare UPIN