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General NPI Number Information
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NPI Number | 1447646484
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Entity Type | Individual
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Provider Name | COLIN DURAND BOETTCHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792-9750
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Country | US
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Telephone | 608-263-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH CT
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City | MIDDLETON
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State | WI
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Zip | 53562-5531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301119053
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 73570-20
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License Number State | WI
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