Provider Demographics
NPI:1417928102
Name:OTTONI, LEO D (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:D
Last Name:OTTONI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1640 FORT STREET SUITE D
Mailing Address - Street 2:ATTN: DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2070 BIDDLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4080
Practice Address - Country:US
Practice Address - Phone:734-225-9100
Practice Address - Fax:734-225-9100
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MILO046410207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2591422Medicaid
MI0H28427OtherBLUE CROSS
MI2591422Medicaid
B38027Medicare UPIN
MION61240005Medicare ID - Type Unspecified