National Provider Identifier
Michael Licata, MD
Michael Licata, MD is listed in the NPPES registry with a primary specialty of Body Imaging Physician in Buffalo, NY and a listed phone number of (716) 649-9000.
Profile Overview
- NPI
- 1306814579
- Provider Type
- Individual
- Primary Specialty
- Body Imaging Physician
- Enumeration Date
- March 14, 2006
- Last Updated
- September 16, 2013
Practice Location
- 2157 Main St
- Buffalo, NY 14214-2648
Phone: (716) 649-9000
Mailing Address
- 3040 Amsdell RD
- Hamburg, NY 14075-5835
Specialties
- Body Imaging Physician (2085B0100X)
- Diagnostic Radiology Physician (2085R0202X)
Full Record
- NPI
- 1306814579
- Entity Type
- Individual
- Last Name
- Licata
- First Name
- Michael
- Name Prefix
- Dr.
- Credential
- MD
- Mailing Street Address
- 3040 Amsdell RD
- Mailing City
- Hamburg
- Mailing State
- NY
- Mailing ZIP Code
- 14075-5835
- Mailing Country
- US
- Mailing Phone
- (716) 649-9000
- Mailing Fax
- (716) 649-9005
- Practice Street Address
- 2157 Main St
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14214-2648
- Practice Country
- US
- Practice Phone
- (716) 649-9000
- Practice Fax
- (716) 649-9005
- Enumeration Date
- March 14, 2006
- Last Updated
- September 16, 2013
- Sex
- Male
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Body Imaging Physician (2085B0100X), Diagnostic Radiology Physician (2085R0202X)
- Other Identifiers
- 00026372703 (NY, Univera Healthcare), 300080525 (NY, Rr Medicare), 040426000284 (NY, Fidelis Care Of New York), 113586FF (NY, Preferred Care), 1609206 (NY, Independent Health), 01528734 (NY), 000523460013 (NY, BCBS)