Healthcare Provider Details

I. General information

NPI: 1548687635
Provider Name (Legal Business Name): BENNET ARTHUR BUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST FL 13
CHICAGO IL
60611-3926
US

IV. Provider business mailing address

259 E ERIE ST FL 13
CHICAGO IL
60611-3926
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-6800
  • Fax: 312-926-6600
Mailing address:
  • Phone: 312-695-6800
  • Fax: 312-926-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-151671
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number036.151671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: