MEDICARE: DR. RAHEEM BUTT DMD

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	1223G0001X	General Practice Dentistry	019.034336	IL

General Provider Information

NPI Number	:	1639858442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAHEEM BUTT DMD

Provider Business Mailing Address
First Line	:	330 MEADOWOOD LN
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1962
Country	:	US
Telephone Number	:	618-303-2970
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N BEADLE DR
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1150
Country	:	US
Telephone Number	:	618-457-2123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	10/09/2023

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Directions to “ DR. RAHEEM BUTT DMD” Practice Location

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