Provider Demographics
NPI:1831139666
Name:BUTLER, CAROL J (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 CAYLOR NICKEL SQ
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2529
Mailing Address - Country:US
Mailing Address - Phone:260-824-3500
Mailing Address - Fax:260-919-3551
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2503
Practice Address - Country:US
Practice Address - Phone:260-919-3300
Practice Address - Fax:260-919-3563
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-09-15
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Provider Licenses
StateLicense IDTaxonomies
IN01050391A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200281630AMedicaid
IN200281630AMedicaid
IN911080E7Medicare PIN