Healthcare Provider Details

I. General information

NPI: 1114964822
Provider Name (Legal Business Name): LOWELL BUTMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN ST
FRANKENMUTH MI
48734-1152
US

IV. Provider business mailing address

4800 FASHION SQUARE BLVD SUITE 510
SAGINAW MI
48604-2612
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-1320
  • Fax: 989-652-1327
Mailing address:
  • Phone: 989-583-7517
  • Fax: 989-583-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301031775
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: