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Individual

DR. MICHAEL LICATA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2157 MAIN ST, BUFFALO, NY 14214-2648
(716) 649-9000
(716) 649-9005
Mailing address
3040 AMSDELL RD, HAMBURG, NY 14075-5835
(716) 649-9000
(716) 649-9005

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
184241-1
NY
2085R0202X
Diagnostic Radiology Physician
184241
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00026372703
UNIVERA HEALTHCARE
NY
01
000523460013
BCBS
NY
05
01528734
NY
01
040426000284
FIDELIS CARE OF NEW YORK
NY
01
113586FF
PREFERRED CARE
NY
01
1609206
INDEPENDENT HEALTH
NY
01
300080525
RR MEDICARE
NY
Enumeration date
03/14/2006
Last updated
09/16/2013
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