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General NPI Number Information
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NPI Number | 1235387283
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Entity Type | Individual
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Provider Name | MONIQUE BUTLER MD
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 97 MONROE ST
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City | DETROIT
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State | MI
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Zip | 48226-2855
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Country | US
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Telephone | 313-227-0065
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Fax | 313-227-0079
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Provider Business Mailing Address
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Address Line | 2422 CEDAR KNOLL DR
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City | TROY
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State | MI
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Zip | 48083-6424
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Country | US
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Telephone | 313-903-4100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301088336
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License Number State | MI
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