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Individual
NICHOLAS P COSTIDAKIS
Active
Individual
NICHOLAS P COSTIDAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000748A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000247376
ANTHEM PROVIDER NUMBER
IN
05
—
100232960
—
IN
01
—
10781139
CAQH
IN
01
—
480034530
MEDICARE RAILROAD NUMBER
IN
Enumeration date
03/11/2006
Last updated
03/22/2021
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