Healthcare Provider Details

I. General information

NPI: 1053057778
Provider Name (Legal Business Name): DAVID ALEXANDER OSTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

464 FOREST ST
WYANDOTTE MI
48192-6819
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4511
  • Fax:
Mailing address:
  • Phone: 313-466-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036176615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: