Organization
SANDUSKY SURGICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHRISTINE C BOTEZAN MD (PRESIDENT)
(810) 648-9670
Entity
Organization
Contact information
Practice address
150 N DELAWARE ST, SANDUSKY, MI 48471-1009
(810) 648-9670
(810) 648-9677
Mailing address
PO BOX 191, SANDUSKY, MI 48471-0191
(810) 648-9670
(810) 648-9677
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4301084929
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4700615
—
MI
Enumeration date
05/28/2006
Last updated
01/03/2008
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