MEDICARE: DR. AMBER KRYSTA BOTROS DO

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	207Q00000X	Family Medicine Physician	05-33755	KS

General Provider Information

NPI Number	:	1730315771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER KRYSTA BOTROS DO

Provider Business Mailing Address
First Line	:	920 MAIN ST
Second Line	:	STE. 170
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-2017
Country	:	US
Telephone Number	:	816-472-1554
Fax Number	:	816-472-1721

Provider Business Practice Location Address
First Line	:	920 MAIN ST
Second Line	:	STE. 170
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-2017
Country	:	US
Telephone Number	:	816-472-1554
Fax Number	:	816-472-1721

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	02/25/2011

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