Provider Demographics
NPI:1942442975
Name:OSTRADICKY, MICHAELA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:
Last Name:OSTRADICKY
Suffix:
Gender:F
Credentials:DPM
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 9086
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-0086
Mailing Address - Country:US
Mailing Address - Phone:206-522-6640
Mailing Address - Fax:206-527-0147
Practice Address - Street 1:1702 DEXTER AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3021
Practice Address - Country:US
Practice Address - Phone:206-522-6640
Practice Address - Fax:206-527-0147
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60074559213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8548521Medicaid
WAPO60074559OtherLICENSE #
WAP00773702OtherRAILROAD MEDICARE
WAPO60074559OtherLICENSE #