Provider Demographics
NPI:1275523409
Name:BUTLER, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
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 1:4040 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6619
Mailing Address - Country:US
Mailing Address - Phone:513-424-0941
Mailing Address - Fax:513-424-9758
Practice Address - Street 1:4040 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6619
Practice Address - Country:US
Practice Address - Phone:513-424-0941
Practice Address - Fax:513-424-9758
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0973102Medicaid
OHBU0761851Medicare ID - Type Unspecified
OH0973102Medicaid