Individual
MONICA L OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1633 N CAPITOL AVE, STE 322, INDIANAPOLIS, IN 46202-1476
(317) 962-2929
(317) 962-2070
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01067231A
IN
207Q00000X
Family Medicine Physician
MD 41929
TN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
01067231A
IN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
2008028219
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200955220
—
IN
01
—
P00831852
RR MEDICARE
IN
Enumeration date
08/10/2007
Last updated
02/13/2018
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