Provider Demographics
NPI:1073629531
Name:OSTER, MICHAEL R (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:OSTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5943 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2618
Mailing Address - Country:US
Mailing Address - Phone:773-282-6111
Mailing Address - Fax:773-725-6600
Practice Address - Street 1:5943 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2618
Practice Address - Country:US
Practice Address - Phone:773-282-6111
Practice Address - Fax:773-725-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005181213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001621735OtherBCBS
IL016005181Medicaid
ILR02400Medicare PIN
ILR01078Medicare PIN
IL0001621735OtherBCBS
ILK50529Medicare PIN