Individual
ANTHONY W BOUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1522 PINE GROVE AVE, SUITE C, PORT HURON, MI 48060-3382
(810) 987-3556
(810) 987-5090
Mailing address
1522 PINE GROVE AVE, SUITE C, PORT HURON, MI 48060-3382
(810) 987-3556
(810) 987-5090
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301070173
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0740213
BCBS
MI
01
—
134086
CARE CHOICE
—
01
—
7115359
AETNA
—
01
—
H66438
HAP
—
Enumeration date
11/20/2006
Last updated
07/08/2007
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