MEDICARE: DR. LAVJAY BUTANI

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	2080P0210X	Pediatric Nephrology Physician	A 067166	CA

General Provider Information

NPI Number	:	1902890023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAVJAY BUTANI

Provider Business Mailing Address
First Line	:	2516 STOCKTON BLVD
Second Line	:	TICON II, 3RD FLOOR
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 STOCKTON BLVD
Second Line	:	TICON II, 3RD FLOOR
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2208
Country	:	US
Telephone Number	:	916-734-8118
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	11/08/2011

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