# KIRK M BOTT DBA LOGAN AVENUE FOOT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639391907
- **Authorized official:** KIRK M BOTT DPM (OWNER)
- **Authorized official phone:** (217) 442-4186

## Contact information

- **Practice address:** 612 N LOGAN AVENUE, DANVILLE, IL 61832
- **Practice address phone:** (217) 442-4186
- **Mailing address:** 612 N LOGAN AVENUE, DANVILLE, IL 61832
- **Mailing address phone:** (217) 442-4186

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016003907 | IL | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 06/18/2008