MEDICARE: MR. ROBERT M BOTNICK PA

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	363A00000X	Physician Assistant	44	CO

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	:	1275620155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT M BOTNICK PA

Provider Business Mailing Address
First Line	:	4900 S MONACO ST
Second Line	:	STE 210
City	:	DENVER
State	:	CO
Zip	:	80237-3486
Country	:	US
Telephone Number	:	303-584-8000
Fax Number	:	303-584-8141

Provider Business Practice Location Address
First Line	:	9195 GRANT STREET #120
Second Line	:	NORTH DENVER ORTHOPEDIC SPECIALISTS
City	:	THORNTON
State	:	CO
Zip	:	80229-4386
Country	:	US
Telephone Number	:	303-453-2997
Fax Number	:	303-453-2998

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/08/2013

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