Healthcare Provider Details

I. General information

NPI: 1225291347
Provider Name (Legal Business Name): MICHAEL ROBERT MARKIEWICZ D.D.S, M.P.H, M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

3435 MAIN ST
BUFFALO NY
14214-3001
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-6032
  • Fax: 716-829-3019
Mailing address:
  • Phone: 716-829-6032
  • Fax: 716-829-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number058934
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number286755
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number058934
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number286755
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number286755
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number036138497
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: