Provider Demographics
NPI:1750399978
Name:LAX, MICHAEL B (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:LAX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-464-4686
Mailing Address - Fax:315-464-7106
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-464-4686
Practice Address - Fax:315-464-7106
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1764882083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01128427Medicaid
NY01128427Medicaid
NY56751BMedicare PIN