{
"Npi": {
"NPI": "1992910608",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JERRY MICHAEL BUTTO DO PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5400 FORT ST",
"SecondLineMailingAddress": "SUITE 250",
"MailingAddressCityName": "TRENTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48183-4632",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-671-8500",
"MailingAddressFaxNumber": "734-671-8503",
"FirstLinePracticeLocationAddress": "5400 FORT ST",
"SecondLinePracticeLocationAddress": "SUITE 250",
"PracticeLocationAddressCityName": "TRENTON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48183-4632",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-671-8500",
"PracticeLocationAddressFaxNumber": "734-671-8503",
"EnumerationDate": "05/14/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUTTO",
"AuthorizedOfficialFirstName": "JERRY",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "734-671-8500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207VH0002X",
"TaxonomyName": "Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician",
"LicenseNumber": "JB012712",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}