Provider Demographics
NPI:1730315771
Name:BOTROS, AMBER KRYSTA (DO)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:KRYSTA
Last Name:BOTROS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:920 MAIN ST
Mailing Address - Street 2:STE. 170
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2017
Mailing Address - Country:US
Mailing Address - Phone:816-472-1554
Mailing Address - Fax:816-472-1721
Practice Address - Street 1:920 MAIN ST
Practice Address - Street 2:STE. 170
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-2017
Practice Address - Country:US
Practice Address - Phone:816-472-1554
Practice Address - Fax:816-472-1721
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-33755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine