MEDICARE: DR. HANS FREDERICK OTTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	01068802A	IN
2	207K00000X	Allergy & Immunology Physician	44263	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215924477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANS FREDERICK OTTO M.D.

Provider Business Mailing Address
First Line	:	9800 SHELBYVILLE RD
Second Line	:	SUITE #220
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2992
Country	:	US
Telephone Number	:	502-429-8585
Fax Number	:	855-656-7325

Provider Business Practice Location Address
First Line	:	5001 HOUSTON RD
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042
Country	:	US
Telephone Number	:	859-980-7180
Fax Number	:	855-656-7325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	03/16/2021

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