Provider Demographics
NPI:1104166503
Name:EVANSVILLE INTEGRATIVE MEDICINE PC
Entity type:Organization
Organization Name:EVANSVILLE INTEGRATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-401-4222
Mailing Address - Street 1:3700 BELLEMEADE AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0102
Mailing Address - Country:US
Mailing Address - Phone:812-401-4222
Mailing Address - Fax:812-401-5722
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:STE 105
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0102
Practice Address - Country:US
Practice Address - Phone:812-401-4222
Practice Address - Fax:812-401-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059401A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1780600353OtherNPI (PHYSICIAN)
IN128784Medicare UPIN