Kirk M Bott Dba Logan Avenue Foot Clinic

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016003907 Issued in IL

Legal business name

KIRK M BOTT DBA LOGAN AVENUE FOOT CLINIC

Practice address

612 N Logan Avenue
Danville, IL 61832

Phone

(217) 442-4186

NPI assigned

May 3, 2007

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kirk M Bott, DPMNPI 1376655019

Title

Owner

Phone

(217) 442-4186

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kirk M Bott, DPM

  • Podiatrist
  • Danville, IL
  • NPI 1376655019
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1639391907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 N LOGAN AVENUE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "61832",
            "telephone_number": "217-442-4186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N LOGAN AVENUE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "61832",
            "telephone_number": "217-442-4186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRK M BOTT DBA LOGAN AVENUE FOOT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "BOTT",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-442-4186",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016003907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1649379504",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CE0883",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE INDIVID",
            "identifier": "P00380788",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1376655019",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4449930001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE INDIVID",
            "identifier": "480010681",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lalita Ryvette King-Hoskins
• Joanne King, PH.D.
• Kevin King, DMD
• Robert Claire King, CRNA
• Teresa Lynn Kinney, APRN
• Neil Kirkpatrick, RN
• Bekki Kist
• Brandye Lynn Kizer, BS, MHP
• Lukas Knight
• Kort Roderick Knous, MD

• Foot & Ankle Surgery Podiatrist in Danville, IL
• Providers in Danville, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.