Provider Demographics
NPI:1609967652
Name:BUTCHBAKER FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:BUTCHBAKER FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BUTCHBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-278-6411
Mailing Address - Street 1:235 E CHICAGO ST STE 2
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1789
Mailing Address - Country:US
Mailing Address - Phone:517-278-6411
Mailing Address - Fax:517-278-4331
Practice Address - Street 1:235 E CHICAGO ST STE 2
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1789
Practice Address - Country:US
Practice Address - Phone:517-278-6411
Practice Address - Fax:517-278-4331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUTCHBAKER FAMILY PRACTICE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4198064-11Medicaid
MI4198064-11Medicaid
MIG87203Medicare UPIN
MI0N10620Medicare PIN