Individual
DR. JULIE A BOUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3041 COMMERCE DR STE B, FORT GRATIOT, MI 48059-3877
(810) 432-0500
(810) 432-0501
Mailing address
3041 COMMERCE DR STE B, FORT GRATIOT, MI 48059-3877
(810) 432-0500
(810) 432-0501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
JB070145
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0807410461
BLUE CROSS/BLUE SHIELD
MI
05
—
1285749549
—
MI
01
—
383662851
PPOM
MI
05
—
4643528
—
MI
01
—
9153443002
CIGNA HEALTHCARE HMO
MI
Enumeration date
08/20/2006
Last updated
03/19/2026
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