Provider Demographics
NPI:1730148313
Name:BUTLER, BRETT W (DPM)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:W
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64580 VAN DYKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2811
Mailing Address - Country:US
Mailing Address - Phone:586-752-3519
Mailing Address - Fax:
Practice Address - Street 1:64580 VAN DYKE RD STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2811
Practice Address - Country:US
Practice Address - Phone:586-752-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB001542213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3040707Medicaid
MIU31681Medicare UPIN
MI0Q37610Medicare PIN