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NPI Code Detail

MEDICARE: CRAIG RONALD OTTENI MD

MEDICARE: CRAIG RONALD OTTENI MD
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
1207Q00000XFamily Medicine PhysicianDR.0056587CO

General Provider Information

NPI Number : 1497193262
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG RONALD OTTENI MD
Provider Business Mailing Address
First Line : PO BOX 429
Second Line :
City : SALIDA
State : CO
Zip : 81201-0429
Country : US
Telephone Number : 719-530-2048
Fax Number : 719-530-2235
Provider Business Practice Location Address
First Line : 28374 COUNTY ROAD 317
Second Line :
City : BUENA VISTA
State : CO
Zip : 81211-9158
Country : US
Telephone Number : 719-395-9048
Fax Number : 719-395-9064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2013
Last Update Date : 02/13/2021

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