Provider Demographics
NPI:1861515504
Name:OTT, MICHAEL COLIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COLIN
Last Name:OTT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4100 LAKE DR SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8292
Mailing Address - Country:US
Mailing Address - Phone:616-974-4511
Mailing Address - Fax:616-356-4102
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8292
Practice Address - Country:US
Practice Address - Phone:616-974-4511
Practice Address - Fax:616-356-4102
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301087717208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery