Healthcare Provider Details

I. General information

NPI: 1417900697
Provider Name (Legal Business Name): LOUIS BUTTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 SKYLYN DR
SPARTANBURG SC
29307-1058
US

IV. Provider business mailing address

PO BOX 406757
ATLANTA GA
30384-6757
US

V. Phone/Fax

Practice location:
  • Phone: 864-573-3272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number21979
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: