Individual
DR. MADHURA NITIN BUTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13770 BEACH BLVD, #6, JACKSONVILLE, FL 32224-7205
(904) 242-4220
(904) 242-4221
Mailing address
13241 BARTRAM PARK BLVD, #209, JACKSONVILLE, FL 32258-5212
(904) 242-4220
(904) 242-4221
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125050936
IL
208000000X
Pediatrics Physician
Primary
ME109013
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013603100
—
FL
Enumeration date
11/24/2008
Last updated
01/23/2015
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