MEDICARE: MICHAEL A PELL MD

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	198878	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00010197101	OTHER	NY	UNIVERA
2	1708440	OTHER	NY	INDEPENDENT HEALTH
3	S1988781	OTHER	NY	WORKERS COMPENSATION
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3174894	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1710987128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A PELL MD

Provider Business Mailing Address
First Line	:	550 ORCHARD PARK RD
Second Line	:	A103
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-677-5500
Fax Number	:	716-677-5008

Provider Business Practice Location Address
First Line	:	550 ORCHARD PARK RD
Second Line	:	A103
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-677-5500
Fax Number	:	716-677-5008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	02/28/2008

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Directions to “ MICHAEL A PELL MD” Practice Location

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