Provider Demographics
NPI:1194377747
Name:BUTLER, SAMUEL LERUSH (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LERUSH
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:LERUSH
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2314 DAHLK CIR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8846
Mailing Address - Country:US
Mailing Address - Phone:608-848-3294
Mailing Address - Fax:
Practice Address - Street 1:2314 DAHLK CIR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8846
Practice Address - Country:US
Practice Address - Phone:608-358-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45576-20207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease