Provider Demographics
NPI:1396810172
Name:BUTSCH, JOHN L (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:BUTSCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT. #313
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-898-5227
Mailing Address - Fax:716-898-5029
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-4024
Practice Address - Fax:716-859-4580
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-01-22
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Provider Licenses
StateLicense IDTaxonomies
IL36105077208600000X
NY254778208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03162943Medicaid
H46975Medicare UPIN