Provider Demographics
NPI:1336563352
Name:BUTTON, MICA
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:BUTTON
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 1:1730 BLAKE ST
Mailing Address - Street 2:B-30
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1283
Mailing Address - Country:US
Mailing Address - Phone:303-304-4128
Mailing Address - Fax:970-785-2700
Practice Address - Street 1:1730 BLAKE ST
Practice Address - Street 2:SUITE B-30
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1283
Practice Address - Country:US
Practice Address - Phone:303-304-4128
Practice Address - Fax:970-785-2700
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0014556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist