Provider Demographics
NPI:1447786165
Name:OTTO, JAMES RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:OTTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:36014 KINGSLAND CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1145
Mailing Address - Country:US
Mailing Address - Phone:586-792-2948
Mailing Address - Fax:586-792-2948
Practice Address - Street 1:36014 KINGSLAND CT
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1145
Practice Address - Country:US
Practice Address - Phone:586-792-2948
Practice Address - Fax:586-792-2948
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine