MEDICARE: DR. ALBERTO BUTALID MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036070872	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD8320	OTHER	IL	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	208959	OTHER	IL	GROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023070752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERTO BUTALID MD

Provider Business Mailing Address
First Line	:	14505 STATE ROUTE 127
Second Line	:
City	:	CARLYLE
State	:	IL
Zip	:	62231-6485
Country	:	US
Telephone Number	:	618-594-8924
Fax Number	:	618-594-7918

Provider Business Practice Location Address
First Line	:	14505 STATE ROUTE 127
Second Line	:
City	:	CARLYLE
State	:	IL
Zip	:	62231-6485
Country	:	US
Telephone Number	:	618-594-8924
Fax Number	:	618-594-7918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	03/09/2012

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Directions to “ DR. ALBERTO BUTALID MD” Practice Location

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