Provider Demographics
NPI:1508618786
Name:BUTINCU, EMANOEL (LMT)
Entity Type:Individual
Prefix:
First Name:EMANOEL
Middle Name:
Last Name:BUTINCU
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 AXTELL DR APT 5
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4419
Mailing Address - Country:US
Mailing Address - Phone:734-858-0359
Mailing Address - Fax:
Practice Address - Street 1:3150 LIVERNOIS RD STE 140
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5000
Practice Address - Country:US
Practice Address - Phone:248-264-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist