Provider Demographics
NPI:1194023275
Name:WATTS, MICHAEL ROBERT (LMT,CKTP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:WATTS
Suffix:
Gender:M
Credentials:LMT,CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1756
Mailing Address - Country:US
Mailing Address - Phone:716-308-7192
Mailing Address - Fax:716-632-2492
Practice Address - Street 1:704 BEACH RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1756
Practice Address - Country:US
Practice Address - Phone:716-308-7192
Practice Address - Fax:716-632-2492
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist