Provider Demographics
NPI:1669488813
Name:OTERO, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 190990
Mailing Address - Street 2:HATO REY STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0990
Mailing Address - Country:US
Mailing Address - Phone:787-769-2477
Mailing Address - Fax:787-276-0065
Practice Address - Street 1:ROAD # 3 KM12.3
Practice Address - Street 2:65 AVENUE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-2477
Practice Address - Fax:787-276-0065
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10,007207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89194OtherPROVIDER NUMBER