MEDICARE: CARMEN J ORTIZ-BUTCHER MD PA

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	207RN0300X	Nephrology Physician	ME 45129	FL

General Provider Information

NPI Number	:	1871836296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMEN J ORTIZ-BUTCHER MD PA

Provider Business Mailing Address
First Line	:	6305 CABALLERO BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3218
Country	:	US
Telephone Number	:	786-546-4465
Fax Number	:	305-365-8299

Provider Business Practice Location Address
First Line	:	6305 CABALLERO BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3218
Country	:	US
Telephone Number	:	786-546-4465
Fax Number	:	305-365-8299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CARMEN J ORTIZ-BUTCHER
Credential	:	MD
Telephone Number	:	786-546-4465

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	04/03/2013

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