Individual
MICHAEL COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
4967 CROOKS RD, SUITE 120, TROY, MI 48098-5801
(248) 952-1601
(248) 952-5781
Mailing address
4967 CROOKS RD, SUITE 120, TROY, MI 48098-5801
(248) 952-1601
(248) 952-5781
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003192
MI
Other
Enumeration date
09/14/2005
Last updated
07/17/2012
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