Healthcare Provider Details

I. General information

NPI: 1609967652
Provider Name (Legal Business Name): BUTCHBAKER FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E CHICAGO ST STE 2
COLDWATER MI
49036-1789
US

IV. Provider business mailing address

235 E CHICAGO ST STE 2
COLDWATER MI
49036-1789
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-6411
  • Fax: 517-278-4331
Mailing address:
  • Phone: 517-278-6411
  • Fax: 517-278-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013510
License Number StateMI

VIII. Authorized Official

Name: DR. ANGELA KAYE BUTCHBAKER
Title or Position: OWNER PHYSICAN
Credential: D.O.
Phone: 517-278-6411