Provider Demographics
NPI:1275731614
Name:BOTZ, CHAD (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BOTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3864
Mailing Address - Country:US
Mailing Address - Phone:913-530-7576
Mailing Address - Fax:
Practice Address - Street 1:13001 EAST 17TH PLACE
Practice Address - Street 2:FITZSIMONS BUILDING SUITE E3360, CAMPUS BOX B119
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-0001
Practice Address - Country:US
Practice Address - Phone:913-530-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53283207ZP0105X
TXQ5356207ZP0105X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN220001461Medicare PIN