1265422927 NPI number — ANTHONY G BOTTINI MD

Table of content: ANTHONY G BOTTINI MD (NPI 1265422927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265422927 NPI number — ANTHONY G BOTTINI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOTTINI
Provider First Name:
ANTHONY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265422927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8170 33RD AVE S
Provider Second Line Business Mailing Address:
PO BOX 1309 MAIL STOP 21110Q
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55425-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3931 LOUISIANA AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-3123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  29932 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 122691 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 642898300 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42Q67BO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP26227 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0600020 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1016389 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140005376 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2113967 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 772239 . This is a "ARAZ GROUP AMERICAS PPO" identifier . This identifiers is of the category "OTHER".




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