Provider Demographics
NPI:1073580783
Name:IDREES, MUHAMMAD S (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:S
Last Name:IDREES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1118
Mailing Address - Country:US
Mailing Address - Phone:585-637-3905
Mailing Address - Fax:585-637-4990
Practice Address - Street 1:319 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1347
Practice Address - Country:US
Practice Address - Phone:585-599-6446
Practice Address - Fax:585-637-4990
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010001026OtherBLUE CHOICE OF ROCHESTER
NY00525878003OtherBC OF WNY
NY1210879OtherINDEPENDENT HEALTH
NY103440DLOtherPREFERRED CARE
NY02047423Medicaid
NYP03001026OtherBLUE CROSS OF ROCHESTER