Healthcare Provider Details

I. General information

NPI: 1992910608
Provider Name (Legal Business Name): JERRY MICHAEL BUTTO DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 FORT ST SUITE 250
TRENTON MI
48183-4632
US

IV. Provider business mailing address

5400 FORT ST SUITE 250
TRENTON MI
48183-4632
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-8500
  • Fax: 734-671-8503
Mailing address:
  • Phone: 734-671-8500
  • Fax: 734-671-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberJB012712
License Number StateMI

VIII. Authorized Official

Name: DR. JERRY MICHAEL BUTTO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 734-671-8500