Provider Demographics
NPI:1114813326
Name:BUTRUM, BAILEY NICOLE
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NICOLE
Last Name:BUTRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E LOUISIANA ST APT 3252
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3822
Mailing Address - Country:US
Mailing Address - Phone:317-833-4571
Mailing Address - Fax:317-833-4571
Practice Address - Street 1:322 E LOUISIANA ST APT 3252
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3822
Practice Address - Country:US
Practice Address - Phone:317-833-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28244094A2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine