Provider Demographics
NPI:1710908348
Name:BUTLER, MICHAEL P (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2121 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2693
Mailing Address - Country:US
Mailing Address - Phone:716-838-2983
Mailing Address - Fax:716-838-2942
Practice Address - Street 1:3925 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-1738
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:716-250-6555
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0037071213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01034413Medicaid
NYP037078OtherWORKERS COMP
NY41115000203OtherFIDELIS
NY8903851OtherINDEPENDENT HEALTH
NY01034413Medicaid
NY00010250402OtherUNIVERA
NY000500647006OtherBLUE CROSS
NY000500647009OtherBLUE CROSS DME
NYP037078OtherWORKERS COMP
NY8903851OtherINDEPENDENT HEALTH
NY000500647009OtherBLUE CROSS DME
NYRA4841Medicare ID - Type Unspecified