Provider Demographics
NPI:1194775510
Name:BUTLER, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BUTLER
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 1:2601 CHERRY AVE
Mailing Address - Street 2:STE 213
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4203
Mailing Address - Country:US
Mailing Address - Phone:360-479-6041
Mailing Address - Fax:360-405-0768
Practice Address - Street 1:2601 CHERRY AVE
Practice Address - Street 2:STE 213
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4203
Practice Address - Country:US
Practice Address - Phone:360-479-6041
Practice Address - Fax:360-405-0768
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017240207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4324384OtherAETNA
WA75424OtherLABOR & INDUSTRIES
BU8932OtherREGENCE BLUE SHIELD
WA8915346OtherCRIME VICTIMS COMP
WA8178105Medicaid
080006439OtherRAILROAD MEDICARE
080006439OtherRAILROAD MEDICARE
WAG000250405Medicare PIN
4324384OtherAETNA
BU8932OtherREGENCE BLUE SHIELD
WAGAB04732Medicare PIN
WA8915346OtherCRIME VICTIMS COMP
A06899Medicare UPIN
WAG8852194Medicare PIN