Individual
MICHAEL JOSEPH EDBAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3040 AMSDELL RD, HAMBURG, NY 14075-5835
(716) 646-1084
Mailing address
2875 UNION RD, STE 8, CHEEKTOWAGA, NY 14227-1461
(716) 206-1503
(716) 651-9855
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
181545
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010050104
UNIVERA
NY
01
—
000528208005
BC/BS
NY
05
—
01246139
—
NY
01
—
040426002674
FIDELIS
NY
01
—
1209831
INDEPEDENT HEALTH
NY
Enumeration date
06/27/2005
Last updated
11/30/2016
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