Boutt, Anthony Edward

Boutt, Anthony Edward is an individual health care provider with primary practice located at 22250 Providence Dr 408, Southfield MI 48075-4825. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Boutt, Anthony Edward can be contacted via phone (248) 465-4470.

Contact Information

Primary practice address
22250 Providence Dr 408 Southfield MI 48075-4825
Phone: (248) 465-4470
Fax: (248) 465-4471
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 4301030028 Michigan

Profile Details

NPI number 1710981071
LBN Legal business name Boutt, Anthony Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2005
Last updated Dec 19th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710981071 NPPES
Michigan MEDICAID 333564110

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