Individual
DR. CRYSTAL J OTTEMAN
Active
Individual
DR. CRYSTAL J OTTEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036086512
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086512
—
IL
01
—
1617373
BCBS OF IL
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400188340
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
05/23/2006
Last updated
02/04/2015
Update your record
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