Provider Demographics
NPI:1215158597
Name:BUTCHER, MICHAEL BAIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BAIN
Last Name:BUTCHER
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 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3120 BURNET AVE
Practice Address - Street 2:STE. 406
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3091
Practice Address - Country:US
Practice Address - Phone:513-584-8600
Practice Address - Fax:513-584-8620
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-070976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61054Medicare UPIN