Provider Demographics
NPI:1366559759
Name:OTTERS, ANTHONY A (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:OTTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTH HILLS HEALTH CENTER
Mailing Address - Street 2:W129N7055 NORTHFIELD DR.
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-2510
Mailing Address - Fax:
Practice Address - Street 1:NORTH HILLS HEALTH CENTER
Practice Address - Street 2:W129N7055 NORTHFIELD DR.
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31726300Medicaid
F10002Medicare UPIN
WI31726300Medicaid