Basic Information
| Provider Information | |||||||||
| NPI: | 1538113923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTE | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 E BELLEVIEW AVE | ||||||||
| Address2: | NO 124 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 04/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 36720 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 22532 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-26439 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD17558 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 31037 | OK | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 104686285 | 05 | MI | MEDICAID | 02300232 | 05 | NY | MEDICAID | 11458232 | 05 | NM | MEDICAID | 204719301 | 05 | TX | MEDICAID | 649413607A | 05 | GA | MEDICAID | Q36720 | 05 | SC | MEDICAID | 1538113923 | 05 | CA | MEDICAID | 1679513196 | 05 | UT | MEDICAID | 1538113923 | 05 | IA | MEDICAID | 1528113923 | 05 | SD | MEDICAID | 1538113923 | 05 | MO | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 01367200 | 05 | CO | MEDICAID | 100191970B | 05 | KS | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 1538113923 | 05 | WY | MEDICAID | 1538113923 | 05 | MT | MEDICAID | 922436 | 05 | AZ | MEDICAID |