MEDICARE: IMDAD H BUTT MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1003118217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMDAD H BUTT MD PC

Provider Business Mailing Address
First Line	:	2575 SPRING ARBOR RD
Second Line	:	SUITE 200
City	:	JACKSON
State	:	MI
Zip	:	49203-3652
Country	:	US
Telephone Number	:	517-784-0020
Fax Number	:	517-787-8329

Provider Business Practice Location Address
First Line	:	2575 SPRING ARBOR RD
Second Line	:	SUITE 200
City	:	JACKSON
State	:	MI
Zip	:	49203-3652
Country	:	US
Telephone Number	:	517-784-0020
Fax Number	:	517-787-8329

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IMDAD H BUTT
Credential	:	MD
Telephone Number	:	517-784-0020

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	11/19/2010

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