Healthcare Provider Details

I. General information

NPI: 1992758346
Provider Name (Legal Business Name): DAVID R OTTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-2478
US

IV. Provider business mailing address

250 W 96TH ST # 520
INDIANAPOLIS IN
46260-1316
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number01065874A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: