Healthcare Provider Details

I. General information

NPI: 1518055813
Provider Name (Legal Business Name): JAMES THOMAS BUKUTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 EUCLID AVE
CLEVELAND OH
44103
US

IV. Provider business mailing address

4500 EUCLID AVE
CLEVELAND OH
44103
US

V. Phone/Fax

Practice location:
  • Phone: 216-432-7200
  • Fax: 216-432-7253
Mailing address:
  • Phone: 216-432-7200
  • Fax: 216-432-7253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35075293
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: