Provider Demographics
NPI:1609842590
Name:BUTKIEWICZ, KYLE JOHN (M D)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JOHN
Last Name:BUTKIEWICZ
Suffix:
Gender:M
Credentials:M D
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Mailing Address - Street 1:8307 N MERION WAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2733
Mailing Address - Country:US
Mailing Address - Phone:480-661-6869
Mailing Address - Fax:
Practice Address - Street 1:1625 E NORTHERN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3960
Practice Address - Country:US
Practice Address - Phone:602-200-9021
Practice Address - Fax:602-200-9087
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ32623207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G52648Medicare UPIN