Individual
AWAIS BUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3022 S PARK AVE, HERRIN, IL 62948-3721
(618) 988-9777
(618) 988-9097
Mailing address
3022 S PARK AVE, HERRIN, IL 62948-3721
(618) 988-9777
(618) 988-9097
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-131112
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-131112
LICENSE
IL
01
—
1942560172
NPI
IL
Enumeration date
05/22/2012
Last updated
01/30/2014
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