Boutt, Anthony W

Boutt, Anthony W is an individual health care provider with primary practice located at 1522 Pine Grove Ave Suite C, Port Huron MI 48060-3382. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Boutt, Anthony W can be contacted via phone (810) 987-3556.

Contact Information

Primary practice address
1522 Pine Grove Ave Suite C Port Huron MI 48060-3382
Phone: (810) 987-3556
Fax: (810) 987-5090
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 4301070173 Michigan

Profile Details

NPI number 1265506497
LBN Legal business name Boutt, Anthony W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 20th, 2006
Last updated Jul 8th, 2007 - about 18 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 1265506497 NPPES
Michigan Other 0740213 BCBS
Michigan Other H66438 BCBS
Michigan Other 134086 BCBS
Michigan Other 7115359 BCBS

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