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General NPI Number Information
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NPI Number | 1548579832
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Entity Type | Organization
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Legal Business Name | ANDRES O. BOTUYAN MD., SC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 1044 N MOZART ST SUITE 505
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City | CHICAGO
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State | IL
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Zip | 60622-2789
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Country | US
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Telephone | 773-645-0393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 39228
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City | CHICAGO
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State | IL
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Zip | 60639-0228
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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 | PRESIDENT
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Name | DR. ANDRES O. BOTUYAN
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Credential | M.D.
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Telephone | 773-645-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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