Provider Demographics
NPI:1952362733
Name:BUTLER, GEROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:GEROLD
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5230 E STOP 11 RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6398
Mailing Address - Country:US
Mailing Address - Phone:317-528-8921
Mailing Address - Fax:317-528-6916
Practice Address - Street 1:5230 E STOP 11 RD
Practice Address - Street 2:SUITE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6398
Practice Address - Country:US
Practice Address - Phone:317-528-8921
Practice Address - Fax:317-528-6916
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN0125319A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100059940AMedicaid