Provider Demographics
NPI:1982420345
Name:BUTCHBAKER, JAMIE LEE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:BUTCHBAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-3236
Mailing Address - Country:US
Mailing Address - Phone:616-319-1013
Mailing Address - Fax:
Practice Address - Street 1:1105 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-3236
Practice Address - Country:US
Practice Address - Phone:616-319-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health