Healthcare Provider Details

I. General information

NPI: 1609618685
Provider Name (Legal Business Name): MADISON BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR. FLOOR 1, RECEPTION C
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR. FLOOR 1, RECEPTION C
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-9020
  • Fax:
Mailing address:
  • Phone: 734-936-9020
  • Fax: 734-615-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351052759
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: