Provider Demographics
NPI:1174507511
Name:BUTLER, KELLIE SERELEAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:SERELEAS
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:312-263-5517
Mailing Address - Fax:312-263-5565
Practice Address - Street 1:200 S MICHIGAN AVE STE 1550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2424
Practice Address - Country:US
Practice Address - Phone:312-263-5517
Practice Address - Fax:312-263-5565
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093363207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093363Medicaid
IL394460Medicare ID - Type Unspecified