Provider Demographics
NPI:1104875368
Name:MICHAEL D. SLATER, D.O., P.C.
Entity type:Organization
Organization Name:MICHAEL D. SLATER, D.O., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-908-2868
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE. 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:719-692-4342
Practice Address - Street 1:91 GRANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1906
Practice Address - Country:US
Practice Address - Phone:716-908-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0997Medicare PIN