Healthcare Provider Details

I. General information

NPI: 1649781733
Provider Name (Legal Business Name): PRO HEALTH MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 02/09/2023
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 WALTON BLVD
ROCHESTER HILLS MI
48307-6900
US

IV. Provider business mailing address

1266 WALTON BLVD
ROCHESTER HILLS MI
48307-6900
US

V. Phone/Fax

Practice location:
  • Phone: 248-710-2900
  • Fax: 248-710-2905
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NICK BUTTAR
Title or Position: CHAIR/MEDICAL DIRECTOR
Credential: MD
Phone: 248-444-2818