Provider Demographics
NPI:1699013243
Name:BUTSKY, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BUTSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4951
Mailing Address - Country:US
Mailing Address - Phone:734-641-1141
Mailing Address - Fax:734-641-1142
Practice Address - Street 1:917 S MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4951
Practice Address - Country:US
Practice Address - Phone:734-641-1141
Practice Address - Fax:734-641-1142
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program