Healthcare Provider Details

I. General information

NPI: 1871649236
Provider Name (Legal Business Name): FARZANA BUTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 SPRING ARBOR RD SUITE #500
JACKSON MI
49203-3652
US

IV. Provider business mailing address

2575 SPRING ARBOR RD SUITE#500
JACKSON MI
49203-3652
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-5150
  • Fax:
Mailing address:
  • Phone: 517-784-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberNS033633
License Number StateMI

VIII. Authorized Official

Name: NANJAPA C SADASIVAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 517-784-5150