Healthcare Provider Details

I. General information

NPI: 1568417954
Provider Name (Legal Business Name): JOI A BUTLER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W 95TH ST SUITE LL2
OAK LAWN IL
60453-2533
US

IV. Provider business mailing address

4700 W 95TH ST SUITE LL2
OAK LAWN IL
60453-2533
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOI A BUTLER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 708-423-6400