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Individual

DR. DAVID JOHN BOTKIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
227 N DIXIE WAY STE 240, SOUTH BEND, IN 46637-3300
(574) 288-1333
Mailing address
227 N DIXIE WAY STE 240, SOUTH BEND, IN 46637-3300

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040017
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000175977
LOCAL BC/BS ID
IN
05
100092140A
IN
Enumeration date
06/02/2006
Last updated
01/10/2018
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