Provider Demographics
NPI:1013129394
Name:BUTREY, CHARLES M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:BUTREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:1480 CENTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1239
Practice Address - Country:US
Practice Address - Phone:440-937-4600
Practice Address - Fax:440-937-4605
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH0782612Medicaid
OHBU0656413Medicare ID - Type Unspecified
OH0782612Medicaid
OH9389631Medicare PIN