Individual
PAUL STEPHEN COSTANZO
Active
Individual
PAUL STEPHEN COSTANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003700
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H060020
BCBSM
MI
Enumeration date
07/19/2006
Last updated
09/27/2010
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