Provider Demographics
NPI:1346519824
Name:BUTKO, AUDREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:C
Last Name:BUTKO
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 1:4515 E ROWEL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8552
Mailing Address - Country:US
Mailing Address - Phone:480-235-2133
Mailing Address - Fax:
Practice Address - Street 1:9097 E DESERT COVE AVE
Practice Address - Street 2:#100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6710
Practice Address - Country:US
Practice Address - Phone:480-235-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine