Provider Demographics
NPI:1144985417
Name:OTTO, NATALIE BACH (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:BACH
Last Name:OTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:DEANNE
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 STANTON L YOUNG BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5018
Mailing Address - Country:US
Mailing Address - Phone:405-271-2316
Mailing Address - Fax:
Practice Address - Street 1:1717 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3809
Practice Address - Country:US
Practice Address - Phone:312-942-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.079834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine