Provider Demographics
NPI:1275620155
Name:BOTNICK, ROBERT M (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:BOTNICK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:ROBIN
Other - Middle Name:MARC
Other - Last Name:BOTNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:STE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-584-8000
Mailing Address - Fax:303-584-8141
Practice Address - Street 1:9195 GRANT STREET #120
Practice Address - Street 2:NORTH DENVER ORTHOPEDIC SPECIALISTS
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4386
Practice Address - Country:US
Practice Address - Phone:303-453-2997
Practice Address - Fax:303-453-2998
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07440001Medicaid
COCOAAA0978Medicare PIN
B9248Medicare PIN
CO07440001Medicaid
COP00724701Medicare PIN
COCO300144Medicare PIN