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NPI Code Detail

MEDICARE: DR. KELLIE SERELEAS BUTLER MD

MEDICARE: DR. KELLIE SERELEAS BUTLER 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
1207V00000XObstetrics & Gynecology Physician036093363IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174507511
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLIE SERELEAS BUTLER MD
Provider Business Mailing Address
First Line : 200 S MICHIGAN AVE STE 1550
Second Line :
City : CHICAGO
State : IL
Zip : 60604-2424
Country : US
Telephone Number : 312-262-2976
Fax Number : 312-986-8005
Provider Business Practice Location Address
First Line : 200 S MICHIGAN AVE STE 1550
Second Line :
City : CHICAGO
State : IL
Zip : 60604-2424
Country : US
Telephone Number : 312-263-5517
Fax Number : 312-263-5565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 06/11/2024

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