Provider Demographics
NPI:1093033953
Name:FREITAS, MICHAEL STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:FREITAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 WOOD ACRES DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1672
Mailing Address - Country:US
Mailing Address - Phone:716-408-2121
Mailing Address - Fax:
Practice Address - Street 1:3950 E ROBINSON RD
Practice Address - Street 2:
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2041
Practice Address - Country:US
Practice Address - Phone:716-564-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263293207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine