Basic Information
| Provider Information | |||||||||
| NPI: | 1275871485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTT | ||||||||
| FirstName: | AHMAR | ||||||||
| MiddleName: | MANNAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 SPYGLASS CT | ||||||||
| Address2: | |||||||||
| City: | WAUKEE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502638061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147205669 | ||||||||
| FaxNumber: | 5152828090 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152474240 | ||||||||
| FaxNumber: | 5152474239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A0401X | MD-42473 | IA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084P0800X | 272034 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | MD-42473 | IA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 208M00000X | MD-42473 | IA | N | Allopathic & Osteopathic Physicians | Hospitalist | 2084P0800X | MD-42473 | IA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.