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General NPI Number Information
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NPI Number | 1295835452
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Entity Type | Individual
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Provider Name | JAMES OTTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 333 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-3004
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Country | US
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Telephone | 312-469-4136
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Fax | 312-469-2134
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Provider Business Mailing Address
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Address Line | 1416 N MOHAWK ST
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City | CHICAGO
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State | IL
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Zip | 60610-7492
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Country | US
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Telephone | 312-469-4136
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Fax | 312-469-2134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R1F06
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License Number State | MO
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