MEDICARE: MICHAEL A VASQUEZ, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	198880	NY

General Provider Information

NPI Number	:	1588749816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A VASQUEZ, MD, PC

Provider Business Mailing Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2691
Fax Number	:	716-690-2695

Provider Business Practice Location Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2691
Fax Number	:	716-690-2695

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL ANTHONY VASQUEZ
Credential	:	MD
Telephone Number	:	716-690-2691

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	02/15/2013

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