Provider Demographics
NPI:1437149176
Name:BUTT, KHURRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KHURRAM
Middle Name:
Last Name:BUTT
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 1:819 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1003
Mailing Address - Country:US
Mailing Address - Phone:740-922-0000
Mailing Address - Fax:740-922-0025
Practice Address - Street 1:819 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1003
Practice Address - Country:US
Practice Address - Phone:740-922-0000
Practice Address - Fax:740-922-0025
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2230197Medicaid
OHH34453Medicare UPIN
OHBU7295121Medicare ID - Type Unspecified