Provider Demographics
NPI:1316057516
Name:BUTLER, PATRICK J (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 CENTRE WEST DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2173
Mailing Address - Country:US
Mailing Address - Phone:217-585-7910
Mailing Address - Fax:217-529-5168
Practice Address - Street 1:1301 S KOKE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-9252
Practice Address - Country:US
Practice Address - Phone:217-547-9100
Practice Address - Fax:217-547-9263
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-09-27
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Provider Licenses
StateLicense IDTaxonomies
IL036-089026207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089026Medicaid