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Individual

RYAN OTTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1400 43RD ST, KENOSHA, WI 53140-2741
(414) 651-2814
Mailing address
1400 43RD ST, KENOSHA, WI 53140-2741
(414) 651-2814

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8206
WI
363AM0700X
Medical Physician Assistant
IL
IL

Other

Enumeration date
01/30/2022
Last updated
03/16/2026
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