Healthcare Provider Details

I. General information

NPI: 1639137268
Provider Name (Legal Business Name): DIANE ARLENE BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE ARLENE MOORE MD

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6681 RIDGE RD #205
PARMA OH
44129-5713
US

IV. Provider business mailing address

6681 RIDGE RD #205
PARMA OH
44129-5713
US

V. Phone/Fax

Practice location:
  • Phone: 440-842-1121
  • Fax: 440-842-5676
Mailing address:
  • Phone: 440-842-1121
  • Fax: 440-842-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35043685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: