Individual
GARY G OTSUJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DR, 5TH FLOOR, SOUTHFIELD, MI 48075-4825
(248) 849-3441
(248) 849-5389
Mailing address
15990 W 9 MILE RD, SOUTHFIELD, MI 48075-4826
(248) 849-4226
(248) 849-4240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301036749
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176548310
—
MI
Enumeration date
07/28/2005
Last updated
02/24/2011
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