Individual
DR. CRYSTAL J OTTEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 690-4993
(630) 690-2293
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 690-4993
(630) 690-2293
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
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