Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 042241 | KS |
N | 207VG0400X | Gynecologist | A13916 | KS |
NPI | 1295737633 |
---|---|
Provider Name | Charles W Butrick |
First Address | Overland Park, KS 66209-2002 |
Second Address | Overland Park, KS 66209-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-22411 | LICENSE (01) | KS |
A13916 | (02) |