# THOMAS G COSTANTINO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1710926399
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 5101006373 | MI | Yes |

## Other

- **Enumeration date:** 06/06/2006
- **Last updated:** 10/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 111059129 | — | MI |
| 01 | — | 125036 | CARE CHOICES | — |
| 01 | — | 5823153 | BLUE CROSS | MI |
| 01 | — | 791126254 | MEDICARE RAILROAD | — |
| 01 | — | C3241 | M-CARE | — |
| 01 | — | E26804 | HEALTH ALLIANCE PLAN | — |