Healthcare Provider Details

I. General information

NPI: 1144183229
Provider Name (Legal Business Name): MIDLAKES NEUROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH ST STE 302
GENEVA NY
14456-1561
US

IV. Provider business mailing address

200 NORTH ST STE 302
GENEVA NY
14456-1561
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5377
  • Fax: 315-787-5377
Mailing address:
  • Phone: 315-787-5377
  • Fax: 315-787-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: ZIAD RIFAI
Title or Position: MD/OWNER
Credential: MD
Phone: 585-905-0767