Provider Demographics
NPI:1265422927
Name:BOTTINI, ANTHONY G (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:BOTTINI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:PO BOX 1309 MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3931 LOUISIANA AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-5000
Practice Address - Country:US
Practice Address - Phone:952-993-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29932207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
122691OtherU CARE
642898300OtherMEDICAL ASSISTANCE
42Q67BOOtherBCBS
HP26227OtherHEALTH PARTNERS
0600020OtherMEDICA HEALTH PLANS
1016389OtherPREFERRED ONE
140005376OtherRR MEDICARE
2113967OtherFIRST HEALTH PLAN
772239OtherARAZ GROUP AMERICAS PPO
642898300OtherMEDICAL ASSISTANCE
HP26227OtherHEALTH PARTNERS