Provider Demographics
NPI:1730171745
Name:BUTTO, FOUAD M (MD)
Entity type:Individual
Prefix:
First Name:FOUAD
Middle Name:M
Last Name:BUTTO
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 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:3503 E FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1742
Practice Address - Country:US
Practice Address - Phone:813-586-8187
Practice Address - Fax:813-321-6998
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350593402080P0202X
MI43010693752080P0202X
FLME1284042080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000521499OtherANTHEM
OH000000141277OtherANTHEM
OH0779948Medicaid
OH4127774OtherAETNA
OHP00642157OtherRRMC
OH2414116OtherAETNA
OH01732OtherPARAMOUNT
MI4240121Medicaid
OH25-01038OtherUHC
OH477986938OtherTRICARE
MI4240121Medicaid
OH0779948Medicaid