Healthcare Provider Details

I. General information

NPI: 1447633995
Provider Name (Legal Business Name): OTTO Z BOUTIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

1830 S OCEAN DR APT 4711
HALLANDALE BEACH FL
33009-7749
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-1960
  • Fax:
Mailing address:
  • Phone: 732-213-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS15393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: