Basic Information
| Provider Information | |||||||||
| NPI: | 1740275130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTEMAN | ||||||||
| FirstName: | KAROL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30400 TELEGRAPH RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Practice Location | |||||||||
| Address1: | 27780 NOVI RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483773401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483482400 | ||||||||
| FaxNumber: | 2483482991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101010595 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 11445733511 | 05 | MI | MEDICAID | 121909 | 01 | MI | CARECHOICES | OTHER | 144314 | 01 | MI | GLHP | OTHER | 160F376930 | 01 | MI | BCBS GROUP | OTHER | 1656314934 | 01 | MI | BCBS IND | OTHER | 4506740 | 01 | MI | AETNA | OTHER | C5951 | 01 | MI | MCARE | OTHER |