Individual
DR. MARY OTTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
FROEDTERT & MED COLLEGE CLIN - WEST, 9200 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53226
(414) 805-3666
Mailing address
9200 W WISCONSIN AVE, FROEDTERT & MED COLLEGE CLIN - WEST, MILWAUKEE, WI 53226-3522
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27051
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31590300
—
WI
Enumeration date
05/19/2006
Last updated
07/08/2007
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