Healthcare Provider Details

I. General information

NPI: 1013231562
Provider Name (Legal Business Name): DREW RANDALL OOSTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 11/03/2023
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR STE 450
TOLEDO OH
43606
US

IV. Provider business mailing address

2109 HUGHES DR STE 450
TOLEDO OH
43606-5102
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2003
  • Fax: 419-479-6977
Mailing address:
  • Phone: 419-291-2003
  • Fax: 419-479-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.120784
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.120784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: