Provider Demographics
NPI:1881692267
Name:MCMICHAEL, BONNIE A (MD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:A
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2918
Mailing Address - Country:US
Mailing Address - Phone:716-565-1234
Mailing Address - Fax:716-565-1246
Practice Address - Street 1:61 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2918
Practice Address - Country:US
Practice Address - Phone:716-565-1234
Practice Address - Fax:716-565-1246
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0407784OtherIHA
NY000523966004OtherBCBS OF WNY
NY01843145Medicaid
NY00010115603OtherUNIVERA/EXCELLUS
NY0407784OtherIHA
G 18145Medicare UPIN