Provider Demographics
NPI:1942233358
Name:OST, KARL LEO (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:LEO
Last Name:OST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10122 E. 10TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2697
Practice Address - Country:US
Practice Address - Phone:317-355-5717
Practice Address - Fax:317-355-3760
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01063661207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200871800Medicaid
INP01157070OtherRR MEDICARE PTAN
INM400071114Medicare PIN
INP01157070OtherRR MEDICARE PTAN