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NPI Code Detail

MEDICARE: MICHAEL JOSEPH EDBAUER D.O.

MEDICARE: MICHAEL JOSEPH EDBAUER D.O.
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
1208000000XPediatrics Physician181545NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040426002674OTHERNYFIDELIS
2000528208005OTHERNYBC/BS
31209831OTHERNYINDEPEDENT HEALTH
400010050104OTHERNYUNIVERA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932105640
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOSEPH EDBAUER D.O.
Provider Business Mailing Address
First Line : 2875 UNION RD
Second Line : STE 8
City : CHEEKTOWAGA
State : NY
Zip : 14227-1461
Country : US
Telephone Number : 716-206-1503
Fax Number : 716-651-9855
Provider Business Practice Location Address
First Line : 3040 AMSDELL RD
Second Line :
City : HAMBURG
State : NY
Zip : 14075-5835
Country : US
Telephone Number : 716-646-1084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 11/30/2016

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