Provider Demographics
NPI:1871649236
Name:FARZANA BUTT
Entity Type:Organization
Organization Name:FARZANA BUTT
Other - Org Name:ULTRASOUND CLINIC DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANJAPA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SADASIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-784-5150
Mailing Address - Street 1:2575 SPRING ARBOR RD
Mailing Address - Street 2:SUITE#500
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3652
Mailing Address - Country:US
Mailing Address - Phone:517-784-5150
Mailing Address - Fax:
Practice Address - Street 1:2575 SPRING ARBOR RD
Practice Address - Street 2:SUITE #500
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3652
Practice Address - Country:US
Practice Address - Phone:517-784-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINS0336332085R0202X
2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
128472OtherGLP
5970OtherHPL
P71951OtherBCN
300C810210OtherBC
1620009OtherPHP
MI104486551Medicaid
380030OtherM CARE OP
5970OtherHPL
MI0M56920Medicare UPIN