Healthcare Provider Details

I. General information

NPI: 1740222082
Provider Name (Legal Business Name): TERROLD BUTLER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E 75TH ST
CHICAGO IL
60619-2267
US

IV. Provider business mailing address

231 E 75TH ST
CHICAGO IL
60619-2267
US

V. Phone/Fax

Practice location:
  • Phone: 773-955-0300
  • Fax:
Mailing address:
  • Phone: 773-955-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: TERROLD B BUTLER
Title or Position: CEO
Credential: MD
Phone: 773-955-0300