Individual
C. JOE OTTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662
Mailing address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01023383A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
01023383A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0295872
—
OH
05
—
100096120
—
IN
01
—
130005977
RR MEDICARE
IN
05
—
2717847
—
MI
Enumeration date
07/01/2005
Last updated
11/10/2014
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