Provider Demographics
NPI:1780653949
Name:BUTLER, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7172
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:3930 NORTHWOODS DR
Practice Address - Street 2:MAIL STOP 32800A
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6974
Practice Address - Country:US
Practice Address - Phone:651-490-6700
Practice Address - Fax:651-490-6730
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-10-05
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Provider Licenses
StateLicense IDTaxonomies
MN29204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN286582300Medicaid
E10254Medicare UPIN
MN286582300Medicaid