Healthcare Provider Details

I. General information

NPI: 1861495533
Provider Name (Legal Business Name): VINCENT BENEDICT OSTROWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 N SHADELAND AVE STE 150
INDIANAPOLIS IN
46250-2095
US

IV. Provider business mailing address

7440 N SHADELAND AVE STE 150
INDIANAPOLIS IN
46250-2095
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-4901
  • Fax: 317-842-4393
Mailing address:
  • Phone: 317-842-4901
  • Fax: 317-842-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number01056562A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: