Healthcare Provider Details

I. General information

NPI: 1700869153
Provider Name (Legal Business Name): KATHY M OSTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 ROUND VALLEY DR #102
PARK CITY UT
84060-7548
US

IV. Provider business mailing address

750 ROUND VALLEY DR #102
PARK CITY UT
84060-7548
US

V. Phone/Fax

Practice location:
  • Phone: 435-655-0926
  • Fax: 435-649-3748
Mailing address:
  • Phone: 435-655-0926
  • Fax: 435-649-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2267782-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: