Provider Demographics
NPI:1578556973
Name:BUTT, SHIRAZ M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRAZ
Middle Name:M
Last Name:BUTT
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 1:351 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-268-8850
Mailing Address - Fax:630-268-1258
Practice Address - Street 1:120 E OGDEN AVE #222
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-268-8850
Practice Address - Fax:630-268-1258
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361006682084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4966001OtherMEDICARE PTAN
IL036100668Medicaid
I24646Medicare UPIN
IL036100668Medicaid