Provider Demographics
NPI:1801899943
Name:BUTLER, CANDILEE (MD)
Entity type:Individual
Prefix:DR
First Name:CANDILEE
Middle Name:
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:419-841-6600
Practice Address - Street 1:2000 REGENCY COURT
Practice Address - Street 2:100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-841-6600
Practice Address - Fax:419-841-6677
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055279B208600000X
OH35-05-5279208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
602046OtherFAMILY HEALTH PLAN
000000223850OtherANTHEM
3190551003OtherCIGNA
602046OtherBUCKEYE COMMUNITY HEALTH PLAN
OC00981OtherNATIONWIDE
4095581OtherAETNA
1701108OtherUNITED HEALTH CARE
OH0723766Medicaid
00634OtherPARAMOUNT
MI104389718OtherMICHIGAN MEDICAID
OH020053389OtherRAIL ROAD MEDICARE
3190551003OtherCIGNA
OH020053389OtherRAIL ROAD MEDICARE
602046OtherFAMILY HEALTH PLAN