Healthcare Provider Details

I. General information

NPI: 1841450137
Provider Name (Legal Business Name): MICHAEL JOHN CIPOLLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 SOUTH BENZING RD SUITE C
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

3670 SOUTH BENZING RD SUITE C
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-5711
  • Fax: 716-675-1358
Mailing address:
  • Phone: 716-675-5711
  • Fax: 716-675-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number265808-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: