Healthcare Provider Details

I. General information

NPI: 1922292374
Provider Name (Legal Business Name): AMY E. BUTLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH BUTLER

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/08/2025
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S. MARYLAND AVE.
CHICAGO IL
60637
US

IV. Provider business mailing address

9250 S. OAKLEY AVE.
CHICAGO IL
60643
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-4072
  • Fax: 773-926-0696
Mailing address:
  • Phone: 708-415-7500
  • Fax: 312-926-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003139
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: