Provider Demographics
NPI:1558573626
Name:EVANSVILLE INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:EVANSVILLE INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-401-4222
Mailing Address - Street 1:3700 BELLEMEADE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0106
Mailing Address - Country:US
Mailing Address - Phone:812-401-4222
Mailing Address - Fax:812-401-4299
Practice Address - Street 1:3700 BELLEMEADE AVE STE 107
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0106
Practice Address - Country:US
Practice Address - Phone:812-401-4222
Practice Address - Fax:812-401-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059401A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty