MEDICARE: MICHEL BUTLER AP. DIPL.O.M

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	171100000X	Acupuncturist	4123	FL

General Provider Information

NPI Number	:	1811536790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEL BUTLER AP. DIPL.O.M

Provider Business Mailing Address
First Line	:	301 10TH AVE N STE B
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4798
Country	:	US
Telephone Number	:	904-910-8046
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 10TH AVE N STE B
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4798
Country	:	US
Telephone Number	:	904-910-8046
Fax Number	:

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

Provider Enumeration Date	:	12/25/2019
Last Update Date	:	01/06/2020

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