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General NPI Number Information
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NPI Number | 1871649236
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Entity Type | Organization
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Legal Business Name | FARZANA BUTT
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 2575 SPRING ARBOR RD SUITE #500
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City | JACKSON
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State | MI
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Zip | 49203-3652
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Country | US
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Telephone | 517-784-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 SPRING ARBOR RD SUITE#500
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City | JACKSON
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State | MI
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Zip | 49203-3652
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Country | US
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Telephone | 517-784-5150
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NANJAPA C SADASIVAN
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Credential | MD
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Telephone | 517-784-5150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | NS033633
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License Number State | MI
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