Healthcare Provider Details

I. General information

NPI: 1013277714
Provider Name (Legal Business Name): NICHOLAS CHRISTIAN OTTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MCHENRY ST
BURLINGTON WI
53105-1828
US

IV. Provider business mailing address

252 MCHENRY ST
BURLINGTON WI
53105-1828
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-6000
  • Fax:
Mailing address:
  • Phone: 262-767-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036136062
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64397
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036136062
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64397
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: