Healthcare Provider Details

I. General information

NPI: 1174592166
Provider Name (Legal Business Name): FRED O BUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 HARCOURT RD SUITE 205
INDIANAPOLIS IN
46260-2081
US

IV. Provider business mailing address

8301 HARCOURT RD SUITE 205
INDIANAPOLIS IN
46260-2081
US

V. Phone/Fax

Practice location:
  • Phone: 317-228-3393
  • Fax:
Mailing address:
  • Phone: 317-228-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01027009A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: