Provider Demographics
NPI:1033115324
Name:OOSTENDORP, LEON D (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:D
Last Name:OOSTENDORP
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 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE STE 5500
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2565
Practice Address - Country:US
Practice Address - Phone:616-267-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0985694OtherHEALTHPLUS OF MI. HMO
MI382031033104OtherCOMMUNITY CHOICE MICHIGAN
MI020D176410OtherBLUECARE NETWORK GROUP
MI1362819Medicaid
MI382031033OtherGREAT WEST LIFE
MI0675751001OtherCIGNA
MI1730265OtherIBA HEALTH PLANS
MI4013102OtherAETNA
MI0D17641001OtherMEDICARE PLUS BLUE
MI120160OtherPREFERRED CHOICES
MI010001444OtherRAILROAD MEDICARE
MI382031033OtherGREAT WEST LIFE
MI020D176410OtherBLUECARE NETWORK GROUP