Provider Demographics
NPI:1184719601
Name:OSTAHOWSKI, MARK STEVEN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:OSTAHOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WEST WACKERLY STREET
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-839-9937
Mailing Address - Fax:
Practice Address - Street 1:920 WEST WACKERLY STREET
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-839-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMO048872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0560795OtherBLUE PIN
MIOE66012002OtherPPI
MI1802371Medicaid
MI0560795OtherBLUE PIN
MIB45202Medicare UPIN