Provider Demographics
NPI:1023072055
Name:POTEMPA, MICHELE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANN
Last Name:POTEMPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 SNYDER DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9497
Mailing Address - Country:US
Mailing Address - Phone:716-433-8751
Mailing Address - Fax:716-433-8792
Practice Address - Street 1:5879 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-433-8751
Practice Address - Fax:716-433-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525243002OtherBCBS OF WNY
NY0110085OtherINDEPENDENT HEALTH
NY00010365201OtherUNIVERA
NY040426003629OtherFIDELIS
NY01832113Medicaid
NY000525243002OtherBCBS OF WNY
NY040426003629OtherFIDELIS