Provider Demographics
NPI:1306015698
Name:ANTHONY J BUTO, DPM
Entity Type:Organization
Organization Name:ANTHONY J BUTO, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-434-3545
Mailing Address - Street 1:2520 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1929
Mailing Address - Country:US
Mailing Address - Phone:734-434-3545
Mailing Address - Fax:
Practice Address - Street 1:2520 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1929
Practice Address - Country:US
Practice Address - Phone:734-434-3545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB000672213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H11577OtherBCBS
485815273OtherBCBSM
0344120001Medicare NSC
0H11577OtherBCBS