MEDICARE: FARZANA BUTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471V0105X	Vascular Sonography Radiologic Technologist
2	2085R0202X	Diagnostic Radiology Physician	NS033633	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	128472	OTHER	GLP
2	5970	OTHER	HPL
3	P71951	OTHER	BCN
4	300C810210	OTHER	BC
5	1620009	OTHER	PHP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	380030	OTHER	M CARE OP

General Provider Information

NPI Number	:	1871649236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARZANA BUTT

Provider Business Mailing Address
First Line	:	2575 SPRING ARBOR RD
Second Line	:	SUITE#500
City	:	JACKSON
State	:	MI
Zip	:	49203-3652
Country	:	US
Telephone Number	:	517-784-5150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2575 SPRING ARBOR RD
Second Line	:	SUITE #500
City	:	JACKSON
State	:	MI
Zip	:	49203-3652
Country	:	US
Telephone Number	:	517-784-5150
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	NANJAPA C SADASIVAN
Credential	:	MD
Telephone Number	:	517-784-5150

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	04/11/2011

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Directions to “FARZANA BUTT ” Practice Location

Language	Start Address	Practice Location

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