MEDICARE: DR. GEROLD 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
1	208000000X	Pediatrics Physician	0125319A	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	:	1952362733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEROLD BUTLER MD

Provider Business Mailing Address
First Line	:	5230 E STOP 11 RD
Second Line	:	SUITE 250
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-6398
Country	:	US
Telephone Number	:	317-528-8921
Fax Number	:	317-528-6916

Provider Business Practice Location Address
First Line	:	5230 E STOP 11 RD
Second Line	:	SUITE 250
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-6398
Country	:	US
Telephone Number	:	317-528-8921
Fax Number	:	317-528-6916

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/25/2016

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