Individual
DR. LAURA M BUTHOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
650 DAKOTA ST STE A, CRYSTAL LAKE, IL 60012
(815) 455-6000
(815) 356-1104
Mailing address
650 DAKOTA ST STE A, CRYSTAL LAKE, IL 60012-3744
(815) 455-6000
(815) 356-1104
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036086040
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036086040
STATE LICENSE
IL
01
—
370022768
MEDICARE RAILROAD
IL
Enumeration date
05/04/2006
Last updated
01/31/2019
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