Provider Demographics
NPI:1508906769
Name:OSTOSH-KROETSCH, MICHELLE RENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENE
Last Name:OSTOSH-KROETSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:RENE
Other - Last Name:OSTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1080 S. VAN DYKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9635
Mailing Address - Country:US
Mailing Address - Phone:989-269-6042
Mailing Address - Fax:989-269-6052
Practice Address - Street 1:1080 S. VAN DYKE
Practice Address - Street 2:SUITE A
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9635
Practice Address - Country:US
Practice Address - Phone:989-269-6042
Practice Address - Fax:989-269-6052
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant