Provider Demographics
NPI:1073774311
Name:BUTLER, THOMAS E II (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BUTLER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 VILLAGE SQUARE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1103 VILLAGE SQUARE DR STE 200
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1762
Practice Address - Country:US
Practice Address - Phone:419-251-8760
Practice Address - Fax:419-214-6888
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115479204F00000X, 208600000X
PAMD466378204F00000X
OH35.152326208600000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1154790Medicaid
CA0A1154790Medicaid