Provider Demographics
NPI: | 1962451666 |
---|---|
Name: | SLATER, MICHAEL D (DO) |
Entity type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | D |
Last Name: | SLATER |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2372 SWEET HOME RD STE 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | AMHERST |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14228-2330 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 716-834-1191 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 656 N FRENCH RD STE 4 |
Practice Address - Street 2: | |
Practice Address - City: | AMHERST |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14228-2104 |
Practice Address - Country: | US |
Practice Address - Phone: | 716-529-3777 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-09 |
Last Update Date: | 2025-09-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 238212 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 0119764 | Other | IHA |
NY | 02752569 | Medicaid | |
NY | 000528634001 | Other | BLUE CROSS |
NY | 00027642501 | Other | UNIVERA |
NY | 0136241 | Other | GHI PPO |
NY | 238212 | Other | DO LICENSE NUMBER |
NY | 02752569 | Medicaid | |
NY | 00027642501 | Other | UNIVERA |