Healthcare Provider Details

I. General information

NPI: 1639505142
Provider Name (Legal Business Name): JOHN ANTHONY BUTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

10 CENTER DR
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-7650
  • Fax: 502-629-7663
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number59332
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number97-196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: