Healthcare Provider Details

I. General information

NPI: 1316994692
Provider Name (Legal Business Name): GARY OSTAHOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N MILES AVE
HARDIN MT
59034-2356
US

IV. Provider business mailing address

16 N MILES AVE
HARDIN MT
59034-2356
US

V. Phone/Fax

Practice location:
  • Phone: 406-665-2205
  • Fax: 406-665-1159
Mailing address:
  • Phone: 406-665-2205
  • Fax: 406-665-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4466
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: