Provider Demographics
NPI:1093758195
Name:BUTLER, BRIAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 DELAFIELD ST STE 207
Mailing Address - Street 2:UROLOGY ASSOCIATES LTD SC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3403
Mailing Address - Country:US
Mailing Address - Phone:262-446-3593
Mailing Address - Fax:262-446-0480
Practice Address - Street 1:1111 DELAFIELD ST STE 207
Practice Address - Street 2:UROLOGY ASSOCIATES LTD SC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3403
Practice Address - Country:US
Practice Address - Phone:262-446-3593
Practice Address - Fax:262-547-0379
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37350208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32204000Medicaid
G25466Medicare UPIN
WI000546017Medicare PIN
WI32204000Medicaid