Healthcare Provider Details

I. General information

NPI: 1720015639
Provider Name (Legal Business Name): MICHAEL E D ANGELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD BUFFALO MEDICAL GROUP, PC
WILLIAMSVILLE NY
14221-8216
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1146
  • Fax: 716-817-1728
Mailing address:
  • Phone: 716-630-1219
  • Fax: 716-817-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number227302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: