Provider Demographics
NPI:1184832362
Name:OSTA, WALID AREF (MD)
Entity Type:Individual
Prefix:DR
First Name:WALID
Middle Name:AREF
Last Name:OSTA
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 1:3845 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4607
Mailing Address - Country:US
Mailing Address - Phone:313-586-4030
Mailing Address - Fax:313-586-4031
Practice Address - Street 1:3845 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4607
Practice Address - Country:US
Practice Address - Phone:313-586-4030
Practice Address - Fax:313-586-4031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085721207L00000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine