Healthcare Provider Details

I. General information

NPI: 1013458215
Provider Name (Legal Business Name): STEPHANE BUTEAU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHAN BUTEAU M.D

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD STE 100
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

1001 NW 13TH ST STE 201
BOCA RATON FL
33486-2269
US

V. Phone/Fax

Practice location:
  • Phone: 561-292-4949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS7184
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME158280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: