DR. SAMUEL JAMES OTTO (NPI# 1154565273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154565273 |
| Entity Type | Individual |
| Full Name | DR. SAMUEL JAMES OTTO |
| Credential | M.D. |
| Practice Address |
2424 S 90th St Suite 408 Milwaukee WI 53227-2455 |
| Mailing Address |
2376 N 400 E Ste A104 Tooele UT 84074-3413 |
| Practice Telephone | 4143852716 |
| Mailing Telephone | 4358820071 |
| Mailing Fax Number | 4358820073 |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2018-09-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 19702 | WI | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 7223921-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 1154565273 | 05 | |
| WI | 1154565273 | 05 |
| Street Address |
2424 S 90TH ST SUITE 408 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53227-2455 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801100730 | Monica Ann Pedraza | Counselor | 2424 S 90th St, 502, Milwaukee, WI 53227-2455 | 2010-08-03 |
| 1992842272 | Mark A Girzadas | Internal Medicine | 2424 S 90th St, Milwaukee, WI 53227-2455 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205451564 | Ginger Renee Bland | Nurse Practitioner | 11133 W. National Avenue, West Allis, WI 53227 | 2020-06-12 |
| 1003312141 | Dynamic Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 10236 W National Ave, West Allis, WI 53227 | 2018-04-05 |
| 1932572641 | Alissa Kristine Walker | Specialist/Technologist | 11601 W Lincoln Ave, West Allis, WI 53227 | 2015-11-03 |
| 1396155990 | Bradly Earl Helinski | Physical Therapy Assistant | 3023 S 84th St., Milwaukee, WI 53227 | 2014-05-05 |
| 1609299783 | Amy Renee Rozumalski | Occupational Therapy Assistant | 10150 W. National Ave, Suite 150, Premiere Medical Staffing Services, LLC, Milwaukee, WI 53227 | 2014-01-27 |
| 1497098438 | Kathleen Marie Schneider | Physical Therapy Assistant | 3023 S. 84th Street, Milwaukee, WI 53227 | 2013-03-28 |
| 1760723373 | Lee Ann Schraith | Physical Therapy Assistant | 3023 S. 84th St, Milwaukee, WI 53227 | 2013-03-06 |
| 1740520725 | Samantha Lynn Wozniak | Physical Therapist | 3023 S. 84th St., Milwaukee, WI 53227 | 2013-02-27 |
| 1831434901 | Andrew Paul Roeder | Physical Therapy Assistant | 3023 S. 89th Street, Milwaukee, WI 53227 | 2012-11-30 |
| 1538418116 | Christine Wilford | Social Worker | 2044 S 96th Street, West Allis, WI 53227 | 2012-08-29 |
| Find all providers in zip 53227 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376793240 | Raymond Harkavy | Urology | 9440 N. Broadmoor Road, Milwaukee, WI 53217-1309 | 2008-09-26 |
| 1356591978 | Randle E Pollard | Urology | 1233 N. Marshall St., #274, Milwaukee, WI 53202 | 2008-09-19 |
| 1295990190 | Charles Leonard Weisenthal | Urology | 1610 N. Prospect Av., 602, Milwaukee, WI 53202 | 2008-07-21 |
| 1508834193 | Charles F Kidd | Urology | 2801 W. Kinnickinnic River Parkway, Suite 370, Milwaukee, WI 53215 | 2006-03-09 |
| 1962400234 | Emmanuel Sison Manuel | Urology | 3201 S 16th St, Ste 1015, Milwaukee, WI 53215-4537 | 2005-07-12 |
| 1164886644 | Jacob Jipp | Urology | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2016-04-11 |
| 1194133272 | Sophie Ramsay | Urology | 9000 W Wisconsin Ave, Pediatric Urology, Milwaukee, WI 53226-4874 | 2014-08-01 |
| 1619381480 | Susan Jarosz | Urology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2014-06-19 |
| 1063839512 | Kelly Ashton Walker | Urology | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2014-03-22 |
| 1447695317 | Graham Luke Machen | Urology | 9200 W Wisconsin Ave, Milwaukee, WI 53226 | 2013-05-06 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.