| Khristine C Botezan, MD | |
|
150 N Delaware St, Sandusky, MI 48471-1009 | |
| (810) 648-9670 | |
| (810) 648-9677 |
| Full Name | Khristine C Botezan |
|---|---|
| Gender | Female |
| Speciality | General Surgery |
| Experience | 38 Years |
| Location | 150 N Delaware St, Sandusky, Michigan |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912954652 | NPI | - | NPPES |
| 4700615 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 4301084929 (Michigan) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Munson Healthcare Grayling Hospital | Grayling, MI | Hospital |
| Osf St Francis Hospital And Medical Group | Escanaba, MI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Munson Healthcare Grayling | 2062736655 | 64 |
| St Francis Hospital | 5991604753 | 86 |
| Entity Name | Munson Healthcare Otsego Memorial Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1164628426 PECOS PAC ID: 8325942535 Enrollment ID: O20040305000525 |
| Entity Name | Portage Physician Practices Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1225461684 PECOS PAC ID: 6103053509 Enrollment ID: O20131210001058 |
| Entity Name | Munson Healthcare Grayling |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710383351 PECOS PAC ID: 2062736655 Enrollment ID: O20150326000110 |
| Mailing Address | Practice Location Address |
|---|---|
| Khristine C Botezan, MD Po Box 191, Sandusky, MI 48471-0191 Ph: (810) 648-9670 | Khristine C Botezan, MD 150 N Delaware St, Sandusky, MI 48471-1009 Ph: (810) 648-9670 |
Thomas Lee Donnellon, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 120 N Delaware St, Sandusky, MI 48471 Phone: 810-648-3770 |