Provider Demographics
NPI:1922095249
Name:ZIONTS, MICHAEL EVAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EVAN
Last Name:ZIONTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 SHERIDAN DR
Mailing Address - Street 2:UB FAMILY MEDICINE
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9405
Mailing Address - Country:US
Mailing Address - Phone:716-835-9800
Mailing Address - Fax:716-835-9888
Practice Address - Street 1:701 SENECA ST STE 646C
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1351
Practice Address - Country:US
Practice Address - Phone:716-995-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02180270Medicaid
H46386Medicare UPIN
NY02180270Medicaid