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NPI Code Detail

MEDICARE: SANDY BOTROS

MEDICARE: SANDY BOTROS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician125066142IL
2207Q00000XFamily Medicine Physician01079930AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952785487
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDY BOTROS
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number : 317-621-9312
Fax Number : 317-621-6920
Provider Business Practice Location Address
First Line : 7910 E WASHINGTON ST STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-5563
Country : US
Telephone Number : 317-355-7171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2015
Last Update Date : 01/05/2026

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Directions to “ SANDY BOTROS ” Practice Location

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