Healthcare Provider Details

I. General information

NPI: 1710908348
Provider Name (Legal Business Name): MICHAEL P BUTLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 SHERIDAN DR
BUFFALO NY
14226-1738
US

IV. Provider business mailing address

2121 MAIN ST
BUFFALO NY
14214-2693
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-9999
  • Fax: 716-250-6555
Mailing address:
  • Phone: 716-838-2983
  • Fax: 716-838-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0037071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: