Provider Demographics
NPI:1417141235
Name:DAVID N BUTLER MD SC
Entity Type:Organization
Organization Name:DAVID N BUTLER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-254-5350
Mailing Address - Street 1:PO BOX 805686
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4118
Mailing Address - Country:US
Mailing Address - Phone:773-254-5350
Mailing Address - Fax:773-254-5353
Practice Address - Street 1:2001 S CALIFORNIA AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2405
Practice Address - Country:US
Practice Address - Phone:773-254-5350
Practice Address - Fax:773-254-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086271207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001608258OtherBCBS OF ILLINOIS
IL036086271Medicaid
IL0001608258OtherBCBS OF ILLINOIS