Healthcare Provider Details

I. General information

NPI: 1114679925
Provider Name (Legal Business Name): KEVIN OSTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

IV. Provider business mailing address

1675 VAN WAGONER DR
SAGINAW MI
48638-4488
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-4263
  • Fax:
Mailing address:
  • Phone: 989-274-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704301549
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704301549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: