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General NPI Number Information
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NPI Number | 1669861548
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Entity Type | Individual
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Provider Name | DAVIETTA BUTTY
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Gender | Female
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 4855 S MOORLAND RD
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 262-432-7599
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Fax | 262-432-7694
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Provider Business Mailing Address
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Address Line | 1630 W 33RD PL
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City | CHICAGO
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State | IL
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Zip | 60608-6202
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Country | US
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Telephone | 248-761-6924
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 66509-20
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License Number State | WI
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