Individual
MICHAEL D LACIVITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6325 MAIN ST, SUITE 200, WILLIAMSVILLE, NY 14221-5822
(716) 630-1295
(716) 250-5999
Mailing address
425 ESSJAY RD STE 170, WILLIAMSVILLE, NY 14221-8235
(716) 630-1219
(716) 817-1726
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
N0060261
NY
213ES0131X
Foot Surgery Podiatrist
Primary
002240
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02676171
—
NY
Enumeration date
07/17/2006
Last updated
07/25/2019
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