Provider Demographics
NPI:1497953749
Name:OTTING, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:OTTING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3455
Mailing Address - Country:US
Mailing Address - Phone:567-408-7703
Mailing Address - Fax:567-408-7702
Practice Address - Street 1:5085 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:567-408-7703
Practice Address - Fax:567-408-7702
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191166208100000X
MI5315051155208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055369Medicaid
MI1497953749Medicaid
OHSS00OtherBWC
OH000000724352OtherANTHEM
OH6612962OtherCIGNA
MI1497953749Medicaid
OH0055369Medicaid
OH000000724352OtherANTHEM