Individual
EMAD BOTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 319-3000
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
42125-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33325300
—
WI
01
—
P00150206
RAILROAD MEDICARE
WI
Enumeration date
05/31/2006
Last updated
06/05/2012
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