Provider Demographics
NPI:1285620203
Name:BUTCHKO, GARY J (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:BUTCHKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:412 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2185
Mailing Address - Country:US
Mailing Address - Phone:216-402-2353
Mailing Address - Fax:977-991-4775
Practice Address - Street 1:11100 EUCLID AVE # MS 6011
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-402-2353
Practice Address - Fax:877-991-4775
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.073196208000000X, 2080P0202X
TXP74022080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics