MEDICARE: WHEATFIELD FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770627622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEATFIELD FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	3799 COMMERCE CT
Second Line	:	SUITE 100
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2024
Country	:	US
Telephone Number	:	716-693-5463
Fax Number	:	716-693-6370

Provider Business Practice Location Address
First Line	:	3799 COMMERCE CT
Second Line	:	SUITE 100
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2024
Country	:	US
Telephone Number	:	716-693-5463
Fax Number	:	716-693-6370

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CHAD E SZYMANSKI
Credential	:	D.O.
Telephone Number	:	716-693-5463

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/12/2010

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