| Dr Michael Licata, MD | |
|
2157 Main St, Buffalo, NY 14214-2648 | |
| (716) 649-9000 | |
| (716) 649-9005 |
| Full Name | Dr Michael Licata |
|---|---|
| Gender | Male |
| Speciality | Radiology - Body Imaging |
| Location | 2157 Main St, Buffalo, New York |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306814579 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085B0100X | Radiology - Body Imaging | 184241-1 (New York) | Primary |
| 2085R0202X | Radiology - Diagnostic Radiology | 184241 (New York) | Secondary |
| Entity Name | Southtowns Radiology Associates LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295779072 PECOS PAC ID: 9830097542 Enrollment ID: O20031219000381 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Michael Licata, MD 3040 Amsdell Rd, Hamburg, NY 14075-5835 Ph: (716) 649-9000 | Dr Michael Licata, MD 2157 Main St, Buffalo, NY 14214-2648 Ph: (716) 649-9000 |
Dr. Gregory S Shields, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 100 High St, Buffalo, NY 14203 Phone: 716-859-2954 Fax: 716-859-2962 |
Weining Ma, MB Radiology Medicare: Accepting Medicare Assignments Practice Location: Elm And Carlton St, Buffalo, NY 14263 Phone: 716-845-2300 |
Dr. Varun Kumar Chowdhry, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: Elm And Carlton Street, Buffalo, NY 14263 Phone: 716-845-2300 |
Drew Frederick Pierce, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 219 Bryant St, Buffalo, NY 14222 Phone: 716-878-7000 |
Rachel Leafe, RT(R), RDMS Radiology Medicare: Not Enrolled in Medicare Practice Location: 414 Virginia St, Buffalo, NY 14201 Phone: 716-427-4541 |
Michael Kuettel, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: Elm And Carlton St, Buffalo, NY 14263 Phone: 716-845-2300 Fax: 716-845-8254 |
Robert E Lutnick, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 222 Genesee Street, Buffalo, NY 14203 Phone: 716-855-2866 |