Healthcare Provider Details

I. General information

NPI: 1386649721
Provider Name (Legal Business Name): STANLEY R MICHALSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL DR.
WILLIAMSVILLE NY
14221
US

IV. Provider business mailing address

400 INTERNATIONAL DR.
WILLIAMSVILLE NY
14221
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-3555
  • Fax: 716-631-9525
Mailing address:
  • Phone: 716-631-3555
  • Fax: 716-631-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number108355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: