Provider Demographics
NPI:1568495356
Name:TIMOTHY J BUTLER, DPM P.C.
Entity type:Organization
Organization Name:TIMOTHY J BUTLER, DPM P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:I
Authorized Official - Credentials:DPM
Authorized Official - Phone:618-692-9700
Mailing Address - Street 1:235B S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1921
Mailing Address - Country:US
Mailing Address - Phone:618-692-9700
Mailing Address - Fax:
Practice Address - Street 1:235B S MAIN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1921
Practice Address - Country:US
Practice Address - Phone:618-692-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty