Provider Demographics
NPI:1912169681
Name:GUPPENBERGER, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:GUPPENBERGER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1526 WALDEN AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4985
Mailing Address - Country:US
Mailing Address - Phone:716-655-0541
Mailing Address - Fax:
Practice Address - Street 1:5360 GENESEE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1044
Practice Address - Country:US
Practice Address - Phone:716-681-5077
Practice Address - Fax:716-887-5801
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2011-08-18
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Provider Licenses
StateLicense IDTaxonomies
NY249112-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry