=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053057778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ALEXANDER OSTMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2022
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 N MAIN ST
-----------------------------------------------------
City | ANNA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62906-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-833-4511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 464 FOREST ST
-----------------------------------------------------
City | WYANDOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48192-6819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-466-0595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 036176615
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------