Provider Demographics
NPI:1871562165
Name:BUTTO, JERRY (DO)
Entity type:Individual
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First Name:JERRY
Middle Name:
Last Name:BUTTO
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Gender:M
Credentials:DO
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Mailing Address - Street 1:5400 FORT ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4632
Mailing Address - Country:US
Mailing Address - Phone:734-671-8500
Mailing Address - Fax:734-671-8503
Practice Address - Street 1:5400 FORT ST
Practice Address - Street 2:SUITE 250
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4632
Practice Address - Country:US
Practice Address - Phone:734-671-8500
Practice Address - Fax:734-671-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-10-26
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Provider Licenses
StateLicense IDTaxonomies
MI5101012712207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04321Medicare UPIN