Basic Information
| Provider Information | |||||||||
| NPI: | 1598794992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOBMEIER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 TITUS AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146173532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852668890 | ||||||||
| FaxNumber: | 5853429566 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 TITUS AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146173532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852668890 | ||||||||
| FaxNumber: | 5853429566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125483 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 125483-8 | 01 | NY | WORKERS' COMPENSATION | OTHER | 0803 | 01 | NY | BLUE SHIELD | OTHER | 000921241001 | 01 | NY | HEALTHNOW | OTHER | 100730BJ | 01 | NY | PREFERRED CARE | OTHER | P010125483 | 01 | NY | EXCELLUS BLUE CHOICE | OTHER |