Provider Demographics
NPI:1720046253
Name:AQUINO, MICHAEL D (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:929 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8113
Mailing Address - Country:US
Mailing Address - Phone:716-837-1500
Mailing Address - Fax:716-837-0799
Practice Address - Street 1:564 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1108
Practice Address - Country:US
Practice Address - Phone:716-884-1325
Practice Address - Fax:716-837-0799
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003386213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00762881Medicaid
NY8903879OtherINDEPENDENT HEALTH
NY000500064001OtherBLUE CROSS/BLUE SHIELD
NY00010250601OtherUNIVERA
NY0079077OtherGHI
NY050110000141OtherFIDELIS
NYT25914Medicare UPIN
NY000500064001OtherBLUE CROSS/BLUE SHIELD
NYDD1828Medicare ID - Type Unspecified