Individual
ANTHONY EDWARD BOUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DR, 408, SOUTHFIELD, MI 48075-4825
(248) 465-4470
(248) 465-4471
Mailing address
15990 W 9 MILE RD, SOUTHFIELD, MI 48075-4826
(248) 849-4226
(248) 849-4240
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301030028
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333564110
—
MI
Enumeration date
06/02/2005
Last updated
12/19/2011
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