Individual
DR. CHANTALE ESTHER BOTHUELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
2424 FORDHAM ST, KEEGO HARBOR, MI 48320-1412
(313) 384-7300
(248) 747-4014
Mailing address
2424 FORDHAM ST, KEEGO HARBOR, MI 48320-1412
(313) 384-7300
(248) 747-4014
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901002140
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2265017
—
MI
Enumeration date
05/14/2007
Last updated
03/09/2017
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