Provider Demographics
NPI:1932185410
Name:BUTLER, CLINTON JAMES (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:JAMES
Last Name:BUTLER
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 1:58144 GRATIOT AVE
Mailing Address - Street 2:PO BOX 480430
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048
Mailing Address - Country:US
Mailing Address - Phone:586-749-5197
Mailing Address - Fax:586-749-5560
Practice Address - Street 1:58144 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048
Practice Address - Country:US
Practice Address - Phone:586-749-5197
Practice Address - Fax:586-749-5560
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14184207Q00000X
MI4301091782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine