Provider Demographics
NPI:1134652506
Name:BUTTS, BREANN N (MD)
Entity Type:Individual
Prefix:
First Name:BREANN
Middle Name:N
Last Name:BUTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:
Other - Last Name:KLUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 15005
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-3000
Mailing Address - Fax:513-636-5859
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:MLC 15005
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-3000
Practice Address - Fax:513-636-5859
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.139487208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program