Individual
DR. ALEC DAVID OTTEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1997 SLOAN PL STE 17, MAPLEWOOD, MN 55117-2051
(651) 772-6251
(651) 294-9661
Mailing address
2854 HIGHWAY 55 STE 130, EAGAN, MN 55121-1776
(651) 224-4930
(651) 842-3391
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
52024
MN
207RN0300X
Nephrology Physician
Primary
52024
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619138849
—
MN
Enumeration date
06/20/2008
Last updated
10/25/2022
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