Provider Demographics
NPI:1235229444
Name:BUTTERWORTH, MICHELLE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23467
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3221
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:500 THURGOOD MARSHALL HWY STE B
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4143
Practice Address - Country:US
Practice Address - Phone:843-355-0255
Practice Address - Fax:843-355-0259
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC532213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1502OtherMEDICAID DME
SCPD5328Medicaid
SC1306430001Medicare ID - Type UnspecifiedRAILROAD
SCDE1502OtherMEDICAID DME
SCU75700Medicare UPIN
SCU757006370Medicare ID - Type Unspecified