Healthcare Provider Details

I. General information

NPI: 1730186933
Provider Name (Legal Business Name): CRAIG ALAN BOTTKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

IV. Provider business mailing address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4970
  • Fax:
Mailing address:
  • Phone: 319-768-4970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA46291
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA46291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: