Organization
CARDIOLOGY READING PANEL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILSON MICHAEL M.D. (AUTHORIZED OFFICIAL)
(716) 887-4093
Entity
Organization
Contact information
Practice address
3 GATES CIR, BUFFALO, NY 14209-1120
(716) 887-4093
(716) 887-5540
Mailing address
3 GATES CIR, BUFFALO, NY 14209-1120
(716) 887-4093
(716) 887-5540
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02077310
—
NY
Enumeration date
06/13/2006
Last updated
08/22/2020
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