Provider Demographics
NPI:1447255658
Name:GALE BUTTO, TONY (DO)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:GALE BUTTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 311A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-728-5600
Practice Address - Fax:231-728-4691
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009434207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI461890011Medicaid
MIF04905Medicare UPIN
MIN33710004Medicare ID - Type Unspecified
MIF04905Medicare UPIN