Individual
DR. MICHELLE DOLORES PENQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 MAIN ST FL 4, BUFFALO, NY 14203-1009
(716) 323-0260
(716) 323-0294
Mailing address
1001 MAIN ST FL 5, BUFFALO, NY 14203-1009
(716) 323-0260
(716) 323-0294
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
200803
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010310201
UNIVERA
—
01
—
000524862001
BC/BS
—
05
—
0018522750001
—
PA
05
—
01776672
—
NY
01
—
040426001461
FIDELIS
—
01
—
3990839
IHA
—
Enumeration date
05/04/2006
Last updated
01/20/2021
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