Provider Demographics
NPI:1295750545
Name:OTT, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OTT
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 1:4603 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4212
Mailing Address - Country:US
Mailing Address - Phone:713-666-3730
Mailing Address - Fax:713-666-3730
Practice Address - Street 1:1635 NORTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1532
Practice Address - Country:US
Practice Address - Phone:281-364-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21484207P00000X
NH7998207P00000X
TXJ0621207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140214133Medicaid
TX140214111Medicaid
TX140214124Medicaid
TX140214134Medicaid
TX8L3583Medicare Oscar/Certification
TX8L3584Medicare Oscar/Certification
C66051Medicare UPIN
TX140214111Medicaid
TXP00690980Medicare Oscar/Certification
TX86187KMedicare PIN