Basic Information
| Provider Information | |||||||||
| NPI: | 1013277714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTEN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 252 MCHENRY ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531051828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627676000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 252 MCHENRY ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531051828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627676000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2012 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 125060987 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 64397 | WI | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.