Provider Demographics
NPI:1184983421
Name:BOTZ, CONRAD CHRISTOPHER II (CST)
Entity type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:CHRISTOPHER
Last Name:BOTZ
Suffix:II
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1357 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-4501
Mailing Address - Country:US
Mailing Address - Phone:715-379-3882
Mailing Address - Fax:
Practice Address - Street 1:1357 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-4501
Practice Address - Country:US
Practice Address - Phone:715-379-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist