Healthcare Provider Details

I. General information

NPI: 1588283634
Provider Name (Legal Business Name): MICHAEL JOSEPH OSTERHOLT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 120
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 120
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2828
  • Fax:
Mailing address:
  • Phone: 509-332-2828
  • Fax: 509-973-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35539
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD61580080
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: