Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036107060 | IL |
Y | 208600000X | Surgeon | 036107060 | IL |
N | 2086S0105X | Surgery of the Hand | 036107060 | IL |
NPI | 1235197088 |
---|---|
Provider Name | Srdjan Andrei Ostric |
First Address | Muskegon, MI 49444-1835 |
Second Address | Muskegon, MI 49444-7807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036107060 | (05) | IL |
I53077 | (02) | IL |