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1356336358

NPI Code Detail

MEDICARE: DR. MICHAEL S BOUTON MD

MEDICARE: DR. MICHAEL S BOUTON MD

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	208600000X	Surgery Physician	R4107	AR
2	208600000X	Surgery Physician	G9329	TX
3	208600000X	Surgery Physician	10920	ND

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	:	1356336358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S BOUTON MD

Provider Business Mailing Address
First Line	:	PO BOX 2010
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58122-0605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 BROADWAY N
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58102-3641
Country	:	US
Telephone Number	:	701-234-2251
Fax Number	:	701-234-2050

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/25/2022

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Directions to “ DR. MICHAEL S BOUTON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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