Provider Demographics
NPI:1366646325
Name:BUTLER, BRETT A (MD)
Entity Type:Individual
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First Name:BRETT
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3207
Mailing Address - Country:US
Mailing Address - Phone:330-602-7702
Mailing Address - Fax:
Practice Address - Street 1:6046 WHIPPLE AVE NW STE 103
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7616
Practice Address - Country:US
Practice Address - Phone:330-588-8900
Practice Address - Fax:330-588-8990
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350788802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI74361Medicare UPIN
OHBU7370971Medicare PIN