Healthcare Provider Details

I. General information

NPI: 1578556973
Provider Name (Legal Business Name): SHIRAZ M BUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E OGDEN AVE #222
HINSDALE IL
60521
US

IV. Provider business mailing address

351 E 17TH ST
LOMBARD IL
60148
US

V. Phone/Fax

Practice location:
  • Phone: 630-268-8850
  • Fax: 630-268-1258
Mailing address:
  • Phone: 630-268-8850
  • Fax: 630-268-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036100668
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036100668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: