Individual
MATHEW OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 646-2550
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 646-2550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3324-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100038892
—
WI
Enumeration date
06/27/2014
Last updated
04/30/2025
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