MEDICARE: ION BOTNARU M.D.

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
1	207R00000X	Internal Medicine Physician	MD60633873	WA
2	207RC0000X	Cardiovascular Disease Physician	MD60633873	WA
3	207RI0011X	Interventional Cardiology Physician	MD60633873	WA
4	207RI0011X	Interventional Cardiology Physician	ME146402	FL
5	207UN0901X	Nuclear Cardiology Physician	ME146402	FL
6	207RC0000X	Cardiovascular Disease Physician	ME146402	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1174796080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ION BOTNARU M.D.

Provider Business Mailing Address
First Line	:	4705 ALT 19 STE B
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1424
Country	:	US
Telephone Number	:	727-787-4875
Fax Number	:	727-786-9623

Provider Business Practice Location Address
First Line	:	4705 ALT 19 STE B
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1424
Country	:	US
Telephone Number	:	727-787-4875
Fax Number	:	727-786-9623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	12/28/2020

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Directions to “ ION BOTNARU M.D.” Practice Location

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