Provider Demographics
NPI:1205879913
Name:OSTROWSKI, LISA A (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:OSTROWSKI
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 1:1007 LINCOLNWAY
Mailing Address - Street 2:POST OFFICE BOX 1539
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3201
Mailing Address - Country:US
Mailing Address - Phone:219-326-2403
Mailing Address - Fax:219-326-2385
Practice Address - Street 1:1007 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46352-0250
Practice Address - Country:US
Practice Address - Phone:219-326-2403
Practice Address - Fax:219-326-2385
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039489A207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE92920Medicare UPIN
IN940640QMedicare ID - Type Unspecified