Provider Demographics
NPI:1013231562
Name:OOSTRA, DREW RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:RANDALL
Last Name:OOSTRA
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 1:2109 HUGHES DR STE 450
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5102
Mailing Address - Country:US
Mailing Address - Phone:419-291-2003
Mailing Address - Fax:419-479-6977
Practice Address - Street 1:2109 HUGHES DR STE 450
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-2003
Practice Address - Fax:419-479-6977
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120784207R00000X, 207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084817Medicaid
OHPENDINGMedicare PIN