Provider Demographics
NPI:1598705428
Name:BUTTON, ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BUTTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 FRANKLIN AVE
Mailing Address - Street 2:#4500
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3551
Mailing Address - Country:US
Mailing Address - Phone:309-662-9631
Mailing Address - Fax:309-662-4706
Practice Address - Street 1:1302 FRANKLIN AVE
Practice Address - Street 2:#4500
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3551
Practice Address - Country:US
Practice Address - Phone:309-828-1166
Practice Address - Fax:309-862-0330
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85001595363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05732097OtherBC GROUP NUMBER
IL071461OtherHEALTH ALLIANCE
IL212636Medicare ID - Type UnspecifiedMC GROUP NUMBER
P39240Medicare UPIN
ILP00282413Medicare ID - Type UnspecifiedRRMC NUMBER
IL071461OtherHEALTH ALLIANCE