Provider Demographics
NPI:1023068640
Name:ORTIZ, G MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:G MICHAEL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 WEST AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6049
Mailing Address - Country:US
Mailing Address - Phone:518-583-0111
Mailing Address - Fax:518-583-2426
Practice Address - Street 1:19 WEST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6049
Practice Address - Country:US
Practice Address - Phone:518-583-0111
Practice Address - Fax:518-583-2426
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY195818-3208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01492488Medicaid
NY10001523OtherCAPITAL DISTRICT PHYSICIA
NYP00291581OtherRAILROAD MEDICARE
NY1099054OtherGHI PPO
NY24118OtherMOHAWK VALLEY PHYSICIANS
NY000434014010OtherBLUE SHIELD OF NORTHEASTE
NY929454OtherGHI HMO
NYG004S24710OtherEMPIRE BCBS
NY000434014010OtherBLUE SHIELD OF NORTHEASTE
NYG004S24710OtherEMPIRE BCBS