Provider Demographics
NPI:1033373287
Name:OSPINA, JOSE ALEJANDRO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:OSPINA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2200 N MAYFAIR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2252
Mailing Address - Country:US
Mailing Address - Phone:414-258-9511
Mailing Address - Fax:414-607-3946
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:818-546-5642
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43011087352085R0202X
FLME1426832085R0202X
CAA1005692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033373287Medicaid
CAP01160904OtherRAILROAD
CAFH759VMedicare PIN