Provider Demographics
NPI:1295737633
Name:BUTRICK, CHARLES W (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:BUTRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6730 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2002
Mailing Address - Country:US
Mailing Address - Phone:913-307-0044
Mailing Address - Fax:913-296-8750
Practice Address - Street 1:6730 W 121ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2002
Practice Address - Country:US
Practice Address - Phone:913-307-0044
Practice Address - Fax:913-948-5380
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA13916207VG0400X
KS042241207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-22411OtherLICENSE
KS04-22411OtherLICENSE