Botkin, David John
Botkin, David John is an individual health care provider with primary practice located at 227 N Dixie Way Ste 240 , South Bend IN 46637-3300. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Botkin, David John can be contacted via phone (574) 288-1333.Contact Information
Primary practice address
227 N Dixie Way Ste 240
South Bend IN 46637-3300
Phone: (574) 288-1333
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 20040017 | Indiana |
Profile Details
| NPI number | 1487692620 |
|---|---|
| LBN Legal business name | Botkin, David John |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 2nd, 2006 |
| Last updated | Jan 10th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487692620 | NPPES |
| Indiana | Other | 000000175977 | LOCAL BC/BS ID |
| Indiana | MEDICAID | 100092140A | LOCAL BC/BS ID |
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