Basic Information
| Provider Information | |||||||||
| NPI: | 1780600353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTSCH | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 JOHN ST STE 12 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477132705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124217489 | ||||||||
| FaxNumber: | 8124360230 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 MULBERRY ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477131252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124217489 | ||||||||
| FaxNumber: | 8124360209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01059401A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 250470 | 01 | IN | MEDICARE GROUP | OTHER | 200887810 | 01 | IN | ECHO - MEDICAID ID | OTHER | 000000557730 | 01 | IN | ANTHEM PIN | OTHER | 000000864546 | 01 | IN | ECHO - BCBS ID# | OTHER | 6410477100 | 05 | KY | MEDICAID | 200079040C | 01 | IN | ECHO - MEDICAID GROUP | OTHER | 200859330G | 01 | IN | MEDICAID GROUP | OTHER |