Provider Demographics
NPI:1780600353
Name:BUTSCH, ANNE E (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:BUTSCH
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 1:501 JOHN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-2705
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-436-0230
Practice Address - Street 1:315 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1252
Practice Address - Country:US
Practice Address - Phone:812-421-7489
Practice Address - Fax:812-436-0209
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059401A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN250470OtherMEDICARE GROUP
IN200887810OtherECHO - MEDICAID ID
IN000000557730OtherANTHEM PIN
IN000000864546OtherECHO - BCBS ID#
KY6410477100Medicaid
IN200079040COtherECHO - MEDICAID GROUP
IN200859330GOtherMEDICAID GROUP
IN250470OtherMEDICARE GROUP
KY6410477100Medicaid
IN000000557730OtherANTHEM PIN
INI28794Medicare UPIN