Provider Demographics
NPI:1780665083
Name:OSTRANDER, JAMES DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:OSTRANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:DOUGLAS
Other - Last Name:OSTRANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4466 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-733-1200
Mailing Address - Fax:810-733-0688
Practice Address - Street 1:4466 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-733-1200
Practice Address - Fax:810-733-0688
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101087207X00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780665083Medicaid
MI0N84700001OtherMEDICARE PIN TERMINATED EFF 053108
MI1215930490OtherGROUP NPI
MI5008702270OtherBCBSM INDIVIDUAL #
MI0N45090OtherMEDICARE GRP PTAN EFF 060108
MI4578018Medicaid
Q06901Medicare UPIN
MI4578027Medicaid