Provider Demographics
NPI:1437392586
Name:OTIS, MEGAN TIFFANY (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:TIFFANY
Last Name:OTIS
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:763-581-9090
Practice Address - Street 1:1001 HART BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8929
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:763-581-9090
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2023-11-30
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Provider Licenses
StateLicense IDTaxonomies
MN53129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine