Provider Demographics
NPI:1013948751
Name:OSTREM, JILL LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:LOUISE
Last Name:OSTREM
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 1:400 PARNASSUS AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0348
Mailing Address - Country:US
Mailing Address - Phone:415-353-2317
Mailing Address - Fax:415-353-2898
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0348
Practice Address - Country:US
Practice Address - Phone:415-353-2311
Practice Address - Fax:415-353-2898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-09-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-06
Provider Licenses
StateLicense IDTaxonomies
CAA721552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A721550Medicaid
CAH86834Medicare UPIN