Provider Demographics
NPI:1669636460
Name:WIEWIORSKI, MICHAEL J (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WIEWIORSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3117 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4813
Mailing Address - Country:US
Mailing Address - Phone:716-257-1254
Mailing Address - Fax:716-215-6170
Practice Address - Street 1:3117 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4813
Practice Address - Country:US
Practice Address - Phone:716-257-1254
Practice Address - Fax:716-215-6170
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2024-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03610363A00000X
NY012796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000530695001OtherBLUE CROSS WNY
NY9515265OtherINDEPENDENT HEALTH
NY9515265OtherINDEPENDENT HEALTH