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NPI Code Detail

MEDICARE: DAVID R OTTO MD

MEDICARE: DAVID R OTTO 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
1207LC0200XCritical Care Medicine (Anesthesiology) Physician01065874AIN

Other Identifiers

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

General Provider Information

NPI Number : 1992758346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID R OTTO MD
Provider Business Mailing Address
First Line : 250 W 96TH ST # 520
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1316
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8050 TOWNSHIP LINE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2478
Country : US
Telephone Number : 317-415-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 04/15/2019

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