MEDICARE: ROBERT KEVIN BUTRYN 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	207W00000X	Ophthalmology Physician	4301064150	MI

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	:	1760584056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KEVIN BUTRYN MD

Provider Business Mailing Address
First Line	:	4033 EASTER SKY DRIVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-932-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4033 EASTER SKY DRIVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-932-9000
Fax Number	:

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	04/11/2012

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