Provider Demographics
NPI:1083821037
Name:BUTLER, DAVID N (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 805686
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4118
Mailing Address - Country:US
Mailing Address - Phone:773-254-5350
Mailing Address - Fax:773-254-5353
Practice Address - Street 1:2001 S CALIFORNIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2486
Practice Address - Country:US
Practice Address - Phone:773-254-5350
Practice Address - Fax:773-254-5353
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036086271207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001608258OtherBCBS OF ILLINOIS
ILG05584Medicare UPIN