Individual
DAVIETTA BUTTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4855 S MOORLAND RD, NEW BERLIN, WI 53151
(262) 432-7599
(262) 432-7694
Mailing address
1630 W 33RD PL, CHICAGO, IL 60608-6202
(248) 761-6924
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
66509-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669861548
—
WI
Enumeration date
01/15/2015
Last updated
07/05/2018
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