Provider Demographics
NPI:1649262296
Name:BUTKUS, MICHAEL (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BUTKUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43200 DEQUINDRE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1707
Mailing Address - Country:US
Mailing Address - Phone:586-799-4350
Mailing Address - Fax:586-799-4279
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:STE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:586-799-4350
Practice Address - Fax:586-799-4279
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66886Medicare UPIN
MI0N14560Medicare ID - Type Unspecified