Provider Demographics
NPI:1740275130
Name:OTTEMAN, KAROL L (DO)
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:L
Last Name:OTTEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:30400 TELEGRAPH RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4537
Mailing Address - Country:US
Mailing Address - Phone:248-353-9460
Mailing Address - Fax:248-353-8084
Practice Address - Street 1:27780 NOVI RD
Practice Address - Street 2:SUITE 108
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3401
Practice Address - Country:US
Practice Address - Phone:248-348-2400
Practice Address - Fax:248-348-2991
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010595207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11445733511Medicaid
MI121909OtherCARECHOICES
MI144314OtherGLHP
MI160F376930OtherBCBS GROUP
MI1656314934OtherBCBS IND
MI4506740OtherAETNA
MIC5951OtherMCARE
MIC5951OtherMCARE
MI11445733511Medicaid