Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | TB013917 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | TB013917 | MI |
NPI | 1528172053 |
---|---|
Provider Name | Dr. Thomas E Butts |
First Address | Hartland, MI 48353-2726 |
Second Address | Brighton, MI 48116-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 27/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190F37120 | BCBS OF MI (01) | MI |
U16590 | (02) | MI |