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NPI Code Detail

MEDICARE: DR. BUDEIAH BOTLA MD

MEDICARE: DR. BUDEIAH BOTLA MD
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
1207L00000XAnesthesiology Physician36056318IL

General Provider Information

NPI Number : 1821048687
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BUDEIAH BOTLA MD
Provider Business Mailing Address
First Line : 701 WINTHROP AVE
Second Line : SUITE 215
City : GLENDALE HEIGHTS
State : IL
Zip : 60139-1405
Country : US
Telephone Number : 630-856-6865
Fax Number : 630-856-6813
Provider Business Practice Location Address
First Line : 701 WINTHROP AVE
Second Line :
City : GLENDALE HEIGHTS
State : IL
Zip : 60139-1405
Country : US
Telephone Number : 630-545-5980
Fax Number : 630-545-5984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 02/12/2013

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