Individual
GRANT WADE BOTKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 EASTVOLD AVE, ORTONVILLE, MN 56278-1133
(320) 839-6157
(320) 839-3851
Mailing address
450 EASTVOLD AVE, ORTONVILLE, MN 56278-1252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
57981
MN
207Q00000X
Family Medicine Physician
9144
SD
Other
Enumeration date
04/20/2011
Last updated
02/28/2024
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