Provider Demographics
NPI:1538188982
Name:BUTH, ERIC P (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:BUTH
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:PO BOX 3525
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47734-3525
Mailing Address - Country:US
Mailing Address - Phone:231-832-5817
Mailing Address - Fax:213-832-8260
Practice Address - Street 1:4499 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8593
Practice Address - Country:US
Practice Address - Phone:231-832-5817
Practice Address - Fax:231-832-8260
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0544902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2933725Medicaid
MI9200011659OtherRAILROAD MEDICARE
MID16289006Medicare PIN
F54710Medicare UPIN