Provider Demographics
NPI:1518213115
Name:OSTGARD, ESTELLE (MD)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:OSTGARD
Suffix:
Gender:F
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:PO BOX 970
Mailing Address - Street 2:MENOMINEE TRIBAL CLINIC
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135-0970
Mailing Address - Country:US
Mailing Address - Phone:715-799-3361
Mailing Address - Fax:715-799-3099
Practice Address - Street 1:W3275 WOLF RIVER ROAD
Practice Address - Street 2:MENOMINEE TRIBAL CLINIC
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135-0970
Practice Address - Country:US
Practice Address - Phone:715-799-3361
Practice Address - Fax:715-799-3099
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL12397207Q00000X
WI64387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100047625Medicaid
ND12083Medicaid
NDN6252Medicare PIN
ND12083Medicaid