Provider Demographics
NPI:1750827556
Name:DANIEL BUTZ M.D., S.C.
Entity Type:Organization
Organization Name:DANIEL BUTZ M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-819-6361
Mailing Address - Street 1:1005 SAN JOSE DR
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2139
Mailing Address - Country:US
Mailing Address - Phone:920-819-6361
Mailing Address - Fax:
Practice Address - Street 1:2350 N LAKE DR STE 304
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-298-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66679-20208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty