Provider Demographics
NPI:1457357212
Name:OSTROWSKI, JONATHAN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALAN
Last Name:OSTROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:A
Other - Last Name:OSTROWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8987 E TANQUE VERDE RD
Mailing Address - Street 2:STE 309-356
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9610
Mailing Address - Country:US
Mailing Address - Phone:520-795-8510
Mailing Address - Fax:520-795-9214
Practice Address - Street 1:8987 E TANQUE VERDE RD
Practice Address - Street 2:STE 309-356
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9610
Practice Address - Country:US
Practice Address - Phone:520-795-8510
Practice Address - Fax:520-795-9214
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ193802081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ296740Medicaid
AZ296740Medicaid
AZMD19380Medicare ID - Type UnspecifiedMEDICARE ID