Provider Demographics
NPI:1245125368
Name:OSTERMAN, MITCHELL DOUGLAS
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DOUGLAS
Last Name:OSTERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17620 80TH AVE NE APT 126
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-6615
Mailing Address - Country:US
Mailing Address - Phone:206-428-8047
Mailing Address - Fax:
Practice Address - Street 1:929 N 130TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7500
Practice Address - Country:US
Practice Address - Phone:253-833-7444
Practice Address - Fax:253-835-9976
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist