Provider Demographics
NPI:1154369197
Name:TINNESZ, MICHAEL DYLAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DYLAN
Last Name:TINNESZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6 FOUNTAIN PLZ
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2211
Mailing Address - Country:US
Mailing Address - Phone:716-691-8838
Mailing Address - Fax:716-564-1134
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-691-8838
Practice Address - Fax:716-564-1134
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2256321207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026552001OtherUNIVERA HEALTHCARE
NYP00038676OtherRAILROAD MEDICARE
NY050110000088OtherFIDELIS
NY3994268OtherINDEPENDENT HEALTH
NY000527809002OtherBLUE CROSS BLUE SHIELD
NY02628260Medicaid
NY02628260Medicaid
NYP00038676OtherRAILROAD MEDICARE