Provider Demographics
NPI:1881955078
Name:OSTROWSKI, ZACHARY MATTHEW (C-PED)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:MATTHEW
Last Name:OSTROWSKI
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8589 GULL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9647
Mailing Address - Country:US
Mailing Address - Phone:269-629-4853
Mailing Address - Fax:269-629-5085
Practice Address - Street 1:8589 GULL RD STE 2
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9647
Practice Address - Country:US
Practice Address - Phone:269-629-4853
Practice Address - Fax:269-629-5085
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICPED3724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist