Individual
DR. VICTORIA ANN OTHERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
362 MERIDIAN PARKE LN STE A, GREENWOOD, IN 46142-9425
(317) 528-8760
(317) 528-8761
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004084A
IN
207Q00000X
Family Medicine Physician
34-007433
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522568
ANTHEM
IN
05
—
200250180A
—
IN
Enumeration date
07/07/2005
Last updated
04/11/2024
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