Organization
COSKIDS PEDIATRICS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH PATICK COSTELLO III M.D. (PRESIDENT)
(618) 233-6685
Entity
Organization
Contact information
Practice address
4212 N ILLINOIS ST, SWANSEA, IL 62226-1835
(618) 233-6685
Mailing address
PO BOX 217, O FALLON, IL 62269-0217
(618) 233-6685
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036079559
IL
Other
Enumeration date
12/22/2008
Last updated
12/22/2008
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