MEDICARE: MICHAEL LAWRENCE BUTERA M.D.

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	207RI0200X	Infectious Disease Physician	G70238	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WG70238C	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104925205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LAWRENCE BUTERA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1009
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91979-1009
Country	:	US
Telephone Number	:	619-508-0908
Fax Number	:	619-693-3242

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD STE 2309
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5241
Country	:	US
Telephone Number	:	619-286-8803
Fax Number	:	619-286-2344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/17/2023

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