Provider Demographics
NPI:1760839179
Name:MATTHEW A. BUTLER, MD, PA
Entity Type:Organization
Organization Name:MATTHEW A. BUTLER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-265-1308
Mailing Address - Street 1:PO BOX 47669
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7669
Mailing Address - Country:US
Mailing Address - Phone:316-712-9235
Mailing Address - Fax:316-219-4141
Practice Address - Street 1:9350 E 35TH ST N
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2019
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36315207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty