Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0601170 | NY |
NPI | 1053499491 |
---|---|
Provider Name | Chairat Butsunturn |
First Address | Niagara Falls, NY 14305-1205 |
Second Address | Niagara Falls, NY 14305-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 19/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010023701 | UNIVERA (01) | NY |
000502232001 | BLUE CROSS BLUE SHIELD (01) | NY |
00606428 | MEDICAID (01) | NY |
040426003450 | FIDELIS (01) | NY |
161136388 | TAX ID (01) | NY |
1900696 | INDEPENDENT HEALTH (01) | NY |
B35654 | (02) | NY |