Healthcare Provider Details

I. General information

NPI: 1972661643
Provider Name (Legal Business Name): ADRIENNE LEE BUTLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N RITCHIE CT APT 8D
CHICAGO IL
60610-4954
US

IV. Provider business mailing address

50 S B B KING BLVD
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 312-505-1226
  • Fax:
Mailing address:
  • Phone: 901-436-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number063036921
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number063036921
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number063036921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: