Provider Demographics
NPI:1235387283
Name:BUTLER, MONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TOMIKA
Other - Middle Name:MONIQUE
Other - Last Name:ROBERTS-BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2422 CEDAR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6424
Mailing Address - Country:US
Mailing Address - Phone:313-903-4100
Mailing Address - Fax:
Practice Address - Street 1:97 MONROE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2855
Practice Address - Country:US
Practice Address - Phone:313-227-0065
Practice Address - Fax:313-227-0079
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H228210OtherBCBSM/BCN
MIP35120187Medicare PIN