Provider Demographics
NPI:1053499491
Name:BUTSUNTURN, CHAIRAT (MD)
Entity Type:Individual
Prefix:
First Name:CHAIRAT
Middle Name:
Last Name:BUTSUNTURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLOMBA DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1205
Mailing Address - Country:US
Mailing Address - Phone:716-285-3464
Mailing Address - Fax:716-285-8520
Practice Address - Street 1:1 COLOMBA DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1205
Practice Address - Country:US
Practice Address - Phone:716-285-3464
Practice Address - Fax:716-285-8520
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0601170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606428OtherMEDICAID
NY1900696OtherINDEPENDENT HEALTH
NY000502232001OtherBLUE CROSS BLUE SHIELD
NY040426003450OtherFIDELIS
NY00010023701OtherUNIVERA
NY161136388OtherTAX ID
NY161136388OtherTAX ID
NYB35654Medicare UPIN
NY34004500Medicare ID - Type UnspecifiedRAILROAD MEDICARE