Healthcare Provider Details

I. General information

NPI: 1093033953
Provider Name (Legal Business Name): MICHAEL STEPHEN FREITAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E ROBINSON RD
WEST AMHERST NY
14228-2041
US

IV. Provider business mailing address

443 WOOD ACRES DR
EAST AMHERST NY
14051-1672
US

V. Phone/Fax

Practice location:
  • Phone: 716-564-1111
  • Fax:
Mailing address:
  • Phone: 716-408-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number263293
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number263293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: