Provider Demographics
NPI:1265143630
Name:MIVAS, P.C.
Entity type:Organization
Organization Name:MIVAS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-877-7000
Mailing Address - Street 1:4927 MAIN STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4081
Mailing Address - Country:US
Mailing Address - Phone:716-877-7000
Mailing Address - Fax:716-322-1164
Practice Address - Street 1:4927 MAIN STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4081
Practice Address - Country:US
Practice Address - Phone:716-877-7000
Practice Address - Fax:716-322-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty