Provider Demographics
NPI:1881691947
Name:OSTROWSKI, LEONARD WALTER JR (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:WALTER
Last Name:OSTROWSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:219-364-3610
Practice Address - Street 1:3125 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4423
Practice Address - Country:US
Practice Address - Phone:219-762-3175
Practice Address - Fax:219-763-3092
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100353010Medicaid
IN000000093872OtherAMTHEM BC/BS
IN080152594OtherRAILROAD MEDICARE
IN100353010Medicaid
IN4157960001Medicare NSC
IN080152594OtherRAILROAD MEDICARE