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General NPI Number Information
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NPI Number | 1629185756
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Entity Type | Organization
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Legal Business Name | PORTLAND ORTHOPAEDIC ASSOCIATES LLC
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1299 PORTLAND AVENUE SUITE 16
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City | ROCHESTER
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State | NY
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Zip | 14621
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Country | US
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Telephone | 585-266-3300
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Fax | 585-266-2163
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Provider Business Mailing Address
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Address Line | 1299 PORTLAND AVENUE SUITE 16
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City | ROCHESTER
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State | NY
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Zip | 14621
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Country | US
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Telephone | 585-266-3300
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Fax | 585-266-2163
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Authorized Official
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Title or Position | SOLO PRACTITIONER
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Name | MICHAEL A NILES
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Credential | MD
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Telephone | 585-266-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 1436371
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License Number State | NY
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