Provider Demographics
NPI:1235197088
Name:OSTRIC, SRDJAN ANDREI (MD)
Entity Type:Individual
Prefix:
First Name:SRDJAN
Middle Name:ANDREI
Last Name:OSTRIC
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 1:1316 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1835
Mailing Address - Country:US
Mailing Address - Phone:231-739-9461
Mailing Address - Fax:231-739-1984
Practice Address - Street 1:1675 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7807
Practice Address - Country:US
Practice Address - Phone:231-739-9461
Practice Address - Fax:231-739-1984
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011085662086S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107060Medicaid
ILI53077Medicare UPIN