Healthcare Provider Details

I. General information

NPI: 1164409991
Provider Name (Legal Business Name): MICHAEL D. CALABRESE, PHYSICIAN P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 ELMWOOD AVE
BUFFALO NY
14222-1836
US

IV. Provider business mailing address

656 ELMWOOD AVE
BUFFALO NY
14222-1836
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-0515
  • Fax: 716-883-8764
Mailing address:
  • Phone: 716-883-0515
  • Fax: 716-883-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL D CALABRESE
Title or Position: PRESIDENT
Credential: M. D.
Phone: 716-883-0515