Healthcare Provider Details

I. General information

NPI: 1598070179
Provider Name (Legal Business Name): DANIEL BUTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 W NORTH AVE STE 110
BROOKFIELD WI
53005-4977
US

IV. Provider business mailing address

1005 SAN JOSE DR
ELM GROVE WI
53122-2139
US

V. Phone/Fax

Practice location:
  • Phone: 262-717-4000
  • Fax: 262-641-7435
Mailing address:
  • Phone: 920-819-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number66679-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: