Individual
DR. MATTHEW MICHAEL OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1410 SW TRADITION DR, STE 110, ANKENY, IA 50023
(515) 875-9696
(515) 875-9697
Mailing address
PO BOX 424, DES MOINES, IA 50302-0424
(515) 875-9255
(515) 875-9223
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO-03731
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184655904
—
IA
05
—
2736009
—
IA
Enumeration date
07/06/2006
Last updated
01/02/2024
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