Individual
DR. SAMUEL JAMES OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2424 S 90TH ST, SUITE 408, MILWAUKEE, WI 53227-2455
(414) 385-2716
Mailing address
2376 N 400 E, STE A104, TOOELE, UT 84074-3413
(435) 882-0071
(435) 882-0073
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
19702
WI
208800000X
Urology Physician
7223921-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154565273
—
UT
05
—
1154565273
—
WI
Enumeration date
04/21/2009
Last updated
09/12/2018
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