Organization
MITCHELL D. BOTNEY, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL D. BOTNEY MD (PRESIDENT)
(314) 692-2228
Entity
Organization
Contact information
Practice address
3009 NORTH NEW BALLAS ROAD, SUITE 256C, ST. LOUIS, MO 63131
(314) 692-2228
Mailing address
3009 NEW BALLAS ROAD, SUITE 256C, ST. LOUIS, MO 63131
(314) 692-2228
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202402947
—
MO
01
—
DE8921
RAILROAD MEDICARE
MO
Enumeration date
05/12/2006
Last updated
05/27/2008
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