OTTE, MICHAEL (MD)

Provider Demographics

• NPI: 1538113923
• Name: OTTE, MICHAEL (MD)
• Entity Type: Individual
• First Name: MICHAEL
• Last Name: OTTE
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 8200 E BELLEVIEW AVE
• Practice Address - Street 2: NO 124
• Practice Address - City: GREENWOOD VILLAGE
• Practice Address - State: CO
• Practice Address - Zip Code: 80111-2803
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2006-05-20
• Last Update Date: 2024-03-29

Provider Licenses

State	License ID	Taxonomies
NE	22532	2085R0202X
KS	04-26439	2085R0202X
HI	MD17558	2085R0202X
OK	31037	2085R0202X
CO	36720	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IA	1538113923	Medicaid
WY	1538113923	Medicaid
TX	204719301	Medicaid
SC	Q36720	Medicaid
CA	1538113923	Medicaid
MT	1538113923	Medicaid
AZ	922436	Medicaid
NY	02300232	Medicaid
UT	1679513196	Medicaid
NM	11458232	Medicaid
MI	104686285	Medicaid
CO	01367200	Medicaid
MO	1538113923	Medicaid
GA	649413607A	Medicaid
KS	100191970B	Medicaid
NE	10025709000	Medicaid
SD	1528113923	Medicaid
NE	84-059792913	Medicaid
TX	204719301	Medicaid
CO	C22564	Medicare PIN
HI	H105434	Medicare PIN
MT	1538113923	Medicaid
CA	1538113923	Medicaid
NE	NA1214009	Medicare PIN
CO	01367200	Medicaid
IA	1538113923	Medicaid
UT	1679513196	Medicaid
AZ	922436	Medicaid
KS	KA3249018	Medicare PIN
CO	392186ZLJ3	Medicare PIN
NE	NA1215009	Medicare PIN
SC	Q36720	Medicaid
CO	CW4498	Medicare PIN
WY	1538113923	Medicaid
CO	CW5488	Medicare PIN