Provider Demographics
NPI:1720402605
Name:BUTTERS, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:BUTTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1498
Mailing Address - Country:US
Mailing Address - Phone:517-205-7766
Mailing Address - Fax:517-205-7767
Practice Address - Street 1:100 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1498
Practice Address - Country:US
Practice Address - Phone:517-205-7766
Practice Address - Fax:517-205-7767
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant