Individual
KATHLEEN M BOTTUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
751 N RUTLEDGE ST STE 1700, SPRINGFIELD, IL 62702
(217) 545-8000
(217) 545-8163
Mailing address
PO BOX 19642, SPRINGFIELD, IL 62794-9642
(217) 545-8000
(217) 545-8163
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-106435
IL
2084P0015X
Psychosomatic Medicine Physician
036-106742
IL
2084P0800X
Psychiatry Physician
Primary
036-106742
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106435
—
IL
Enumeration date
12/13/2005
Last updated
10/20/2020
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