Healthcare Provider Details

I. General information

NPI: 1558392944
Provider Name (Legal Business Name): WOMANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W VIRGINIA AVE
TAMPA FL
33607-6328
US

IV. Provider business mailing address

2716 W VIRGINIA AVE
TAMPA FL
33607-6328
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-8032
  • Fax: 813-875-0227
Mailing address:
  • Phone: 813-875-8032
  • Fax: 813-875-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME61218
License Number StateFL

VIII. Authorized Official

Name: DR. MADELYN E BUTLER
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 813-875-8032