Provider Demographics
NPI:1891763587
Name:RADE, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:RADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:STE A103
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2654
Mailing Address - Country:US
Mailing Address - Phone:716-677-5500
Mailing Address - Fax:716-677-5008
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:STE A103
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2654
Practice Address - Country:US
Practice Address - Phone:716-677-5500
Practice Address - Fax:716-677-5008
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY128302174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00633743Medicaid
NYAA0962Medicare PIN
NY00633743Medicaid
NYB71641Medicare UPIN