Individual
KIRK M BOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
707 N LOGAN AVE, DANVILLE POLYCLINIC, LTD., DANVILLE, IL 61832-4360
(217) 442-4186
(217) 442-8336
Mailing address
707 N LOGAN AVE, DANVILLE POLYCLINIC, LTD., DANVILLE, IL 61832-4360
(217) 442-4186
(217) 442-8336
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003907
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
016003907
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016003907
BCBS OF ILLINOIS
IL
01
—
4449930001
DMERC
—
01
—
480010681
RAILROAD MEDICARE #
—
01
—
5480266
CIGNA
—
01
—
CE0883
RAILROAD MEDICARE GROUP
—
Enumeration date
08/31/2006
Last updated
02/20/2017
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