Provider Demographics
NPI:1306828413
Name:OTT, CHRISTOPHER E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:OTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2603 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5110
Mailing Address - Country:US
Mailing Address - Phone:651-600-3035
Mailing Address - Fax:651-348-8783
Practice Address - Street 1:2603 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5110
Practice Address - Country:US
Practice Address - Phone:651-600-3035
Practice Address - Fax:651-348-8783
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI48815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34518300Medicaid
WI390807236CQOtherUNITY
WIWI01R8OtherJOHN DEERE
WIP00152829OtherRAILROAD MEDICARE
WI13783OtherDEAN
WI392787907005OtherBLUE CROSS
I10000Medicare UPIN
WI34518300Medicaid