Provider Demographics
NPI:1528177193
Name:FOOTE, MICHAEL MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARTIN
Last Name:FOOTE
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 1:6576 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 HONEOYE COMMONS
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471
Practice Address - Country:US
Practice Address - Phone:585-229-2215
Practice Address - Fax:585-229-2210
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101572BFOtherPREFERRED CARE
NY01658626Medicaid
NYP010198718OtherEXCELLUS
NY01658626Medicaid