Provider Demographics
NPI:1962451666
Name:SLATER, MICHAEL D (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SLATER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 N FRENCH RD
Mailing Address - Street 2:STE 4
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2104
Mailing Address - Country:US
Mailing Address - Phone:716-932-7775
Mailing Address - Fax:
Practice Address - Street 1:656 N FRENCH RD STE 4
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2104
Practice Address - Country:US
Practice Address - Phone:716-529-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0119764OtherIHA
NY02752569Medicaid
NY000528634001OtherBLUE CROSS
NY00027642501OtherUNIVERA
NY0136241OtherGHI PPO
NY238212OtherDO LICENSE NUMBER
NY02752569Medicaid
NY00027642501OtherUNIVERA