Provider Demographics
NPI:1386631133
Name:BUTCHER, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BUTCHER
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 1:14651 S BASCOM AVE
Mailing Address - Street 2:#120
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2014
Mailing Address - Country:US
Mailing Address - Phone:408-356-0444
Mailing Address - Fax:408-402-0912
Practice Address - Street 1:14651 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2004
Practice Address - Country:US
Practice Address - Phone:408-356-0444
Practice Address - Fax:408-402-0912
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31760207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C317600Medicare PIN
CAA34695Medicare UPIN