MEDICARE: DAVID N BUTLER MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	036086271	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001608258	OTHER	IL	BCBS OF ILLINOIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417141235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID N BUTLER MD SC

Provider Business Mailing Address
First Line	:	PO BOX 805686
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-4118
Country	:	US
Telephone Number	:	773-254-5350
Fax Number	:	773-254-5353

Provider Business Practice Location Address
First Line	:	2001 S CALIFORNIA AVE
Second Line	:	SUITE #101
City	:	CHICAGO
State	:	IL
Zip	:	60608-2405
Country	:	US
Telephone Number	:	773-254-5350
Fax Number	:	773-254-5353

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID N BUTLER
Credential	:	M.D.
Telephone Number	:	773-254-5350

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	05/03/2012

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