Provider Demographics
NPI:1588262695
Name:BUTTERCUP PEDIATRICS PLLC
Entity type:Organization
Organization Name:BUTTERCUP PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GONNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-316-5492
Mailing Address - Street 1:27524 WESTRIDGE CREEK LN STE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5290
Mailing Address - Country:US
Mailing Address - Phone:773-316-5492
Mailing Address - Fax:
Practice Address - Street 1:27524 WESTRIDGE CREEK LN STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5290
Practice Address - Country:US
Practice Address - Phone:773-316-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty