# PETRONILO R COSTA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1043435340
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 036-046-108 | IL | — |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 036-046-108 | IL | — |
| 2080P0006X | Developmental - Behavioral Pediatrics Physician | 036-046-108 | IL | — |
| 2080P0008X | Pediatric Neurodevelopmental Disabilities Physician | 036-046-108 | IL | — |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | 036-046-108 | IL | Yes |
| 2084P0800X | Psychiatry Physician | 036-046-108 | IL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 036-046-108 | IL | — |

## Other

- **Enumeration date:** 04/13/2007
- **Last updated:** 10/12/2016