Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 35043284B | OH |
Y | 207V00000X | Obstetrician & Gynecologist | 35043284B | OH |
N | 208D00000X | General Practice Physician | 35043284B | OH |
NPI | 1194815431 |
---|---|
Provider Name | Shahid Butt |
First Address | Euclid, OH 44117-1714 |
Second Address | Chardon, OH 44024-7032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 16/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0473116 | (05) | OH |
C02240 | (02) |