Provider Demographics
NPI:1174592166
Name:BUTLER, FRED O (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:O
Last Name:BUTLER
Suffix:
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 1:8301 HARCOURT RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2081
Mailing Address - Country:US
Mailing Address - Phone:317-228-3393
Mailing Address - Fax:
Practice Address - Street 1:8301 HARCOURT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2081
Practice Address - Country:US
Practice Address - Phone:317-228-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027009A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100151530Medicaid
INC24367Medicare UPIN
IN222750BMedicare PIN
P00220818Medicare PIN