Provider Demographics
NPI:1447248968
Name:BOTZ, PATRICK J (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:BOTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-0265
Mailing Address - Country:US
Mailing Address - Phone:989-652-5210
Mailing Address - Fax:
Practice Address - Street 1:1027 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1302
Practice Address - Country:US
Practice Address - Phone:989-652-5210
Practice Address - Fax:989-652-3741
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPB012278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0980551OtherHEALTHPLUS OF MI
MI3356258Medicaid
MI5730050OtherBLUE CROSS BLUE SHIELD MI
MI5790522OtherAETNA
MIG54166Medicare UPIN
MIOM42080002Medicare ID - Type Unspecified