Healthcare Provider Details

I. General information

NPI: 1417311952
Provider Name (Legal Business Name): CARSON OOSTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 11/03/2023
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N MCCORD RD
TOLEDO OH
43615-1753
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-842-3000
  • Fax: 419-842-3047
Mailing address:
  • Phone:
  • Fax:

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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301507017
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number57.027760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: