Provider Demographics
NPI:1093723595
Name:BUTTELMAN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BUTTELMAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BUTTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-832-7802
Mailing Address - Street 1:17075 DEVONSHIRE ST STE 209
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5411
Mailing Address - Country:US
Mailing Address - Phone:818-832-7802
Mailing Address - Fax:818-832-7805
Practice Address - Street 1:17075 DEVONSHIRE ST STE 209
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5411
Practice Address - Country:US
Practice Address - Phone:818-832-7802
Practice Address - Fax:818-832-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478640Medicaid
CAF31914Medicare UPIN
CA00A478640Medicaid