Individual
CHAIRAT BUTSUNTURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 COLOMBA DR, SUITE 2, NIAGARA FALLS, NY 14305-1205
(716) 285-3464
(716) 285-8520
Mailing address
1 COLOMBA DR, SUITE 2, NIAGARA FALLS, NY 14305-1205
(716) 285-3464
(716) 285-8520
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0601170
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010023701
UNIVERA
NY
01
—
000502232001
BLUE CROSS BLUE SHIELD
NY
01
—
00606428
MEDICAID
NY
01
—
040426003450
FIDELIS
NY
01
—
161136388
TAX ID
NY
01
—
1900696
INDEPENDENT HEALTH
NY
Enumeration date
11/02/2006
Last updated
07/19/2011
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