Provider Demographics
NPI:1821131038
Name:BUTLER, PENELOPE JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:JOHNSON
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3657
Mailing Address - Country:US
Mailing Address - Phone:269-388-6000
Mailing Address - Fax:269-388-9000
Practice Address - Street 1:2130 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3657
Practice Address - Country:US
Practice Address - Phone:269-388-6000
Practice Address - Fax:269-388-9000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine