Individual
RUSSELL F. BUTKIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
710 RIVERSIDE DR, WAUPACA, WI 54981-1941
(715) 256-3000
(715) 256-3079
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(715) 256-3000
(715) 256-3079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29613
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080102084
RAILROAD MEDICARE
WI
05
—
31622900
—
WI
Enumeration date
06/17/2006
Last updated
07/30/2021
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