Healthcare Provider Details

I. General information

NPI: 1184979551
Provider Name (Legal Business Name): BILAL BUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST STE 3100
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

PO BOX 19643
SPRINGFIELD IL
62794-9643
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-7363
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number036-144754
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-144754
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036-144754
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: