Provider Demographics
NPI:1023124013
Name:BUTT, FAUZIA KHALID (MD)
Entity type:Individual
Prefix:DR
First Name:FAUZIA
Middle Name:KHALID
Last Name:BUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 SALINA MEADOWS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:750 EAST ADAMS ST
Practice Address - Street 2:SUITE 2W
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:12310
Practice Address - Country:US
Practice Address - Phone:315-464-9535
Practice Address - Fax:315-464-6288
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20870204F00000X
MI4301106429204F00000X
NY214355208600000X, 204F00000X
CAC52883204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285893727Medicaid
MI1285893727Medicaid
MS302I020028Medicare PIN