MEDICARE: DR. FRED O BUTLER M.D.

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	207RH0003X	Hematology & Oncology Physician	01027009A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1174592166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED O BUTLER M.D.

Provider Business Mailing Address
First Line	:	8301 HARCOURT RD
Second Line	:	SUITE 205
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2081
Country	:	US
Telephone Number	:	317-228-3393
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 HARCOURT RD
Second Line	:	SUITE 205
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2081
Country	:	US
Telephone Number	:	317-228-3393
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/19/2021

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Directions to “ DR. FRED O BUTLER M.D.” Practice Location

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