Individual
MR. JOSEPH KENNEDY COSTELLO IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
224 N. 49TH ST. #4A, OMAHA, NE 68132
(402) 659-4247
Mailing address
224 N. 49TH ST. #4A, OMAHA, NE 68132
(402) 659-4247
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
25900
NE
208D00000X
General Practice Physician
PENDING
NE
Other
Enumeration date
07/26/2010
Last updated
01/15/2013
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