Provider Demographics
NPI:1902557390
Name:BUTLER, PARISH SIDNEY
Entity Type:Individual
Prefix:MR
First Name:PARISH
Middle Name:SIDNEY
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PARISH
Other - Middle Name:SIDNEY
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5807 COSTINO LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5964
Mailing Address - Country:US
Mailing Address - Phone:219-614-3164
Mailing Address - Fax:
Practice Address - Street 1:5807 COSTINO LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5964
Practice Address - Country:US
Practice Address - Phone:219-614-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker