Provider Demographics
NPI:1093765844
Name:BUTLER, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:15300 WEST AVE
Mailing Address - Street 2:SUITE 330 EAST BLDG
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-349-6700
Mailing Address - Fax:708-349-6706
Practice Address - Street 1:15300 WEST AVENUE
Practice Address - Street 2:SUITE 300 EAST BLDG
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4684
Practice Address - Country:US
Practice Address - Phone:708-349-6700
Practice Address - Fax:708-349-6706
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073346174400000X
WI3534-320207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073346Medicaid
WI1093765844Medicaid
IL036073346Medicaid