Individual
MR. MARK DAVID OTTMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301049003
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300135781
RAILROAD MEDICARE
—
05
—
4411238
—
MI
Enumeration date
06/21/2006
Last updated
06/07/2018
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