Provider Demographics
NPI:1215924667
Name:BUTT, AMJAD I (MD)
Entity type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:I
Last Name:BUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AMJAD
Other - Middle Name:
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6764
Mailing Address - Country:US
Mailing Address - Phone:334-526-2200
Mailing Address - Fax:334-526-2220
Practice Address - Street 1:101 PARK PL
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6764
Practice Address - Country:US
Practice Address - Phone:334-526-2200
Practice Address - Fax:334-526-2220
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL105617Medicaid
TNG18370Medicare UPIN
AL105617Medicaid
AL510I060063Medicare PIN
TN3332304Medicare ID - Type Unspecified