Provider Demographics
NPI:1548210487
Name:BUTT, IMDAD HUSSAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMDAD
Middle Name:HUSSAIN
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 1:2575 SPRING ARBOR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203
Mailing Address - Country:US
Mailing Address - Phone:517-784-0020
Mailing Address - Fax:517-787-8329
Practice Address - Street 1:2575 SPRING ARBOR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203
Practice Address - Country:US
Practice Address - Phone:517-784-0020
Practice Address - Fax:517-787-8329
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIB040769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0387749OtherBCBS
MI0387749Medicare ID - Type Unspecified
B47069Medicare UPIN