Individual
FREDERICK M COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8854 W EMERALD ST STE 260, BOISE, ID 83704-4860
(208) 398-4306
Mailing address
8854 W EMERALD ST STE 260, BOISE, ID 83704-4860
(208) 398-4306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200400112
NC
207RI0011X
Interventional Cardiology Physician
Primary
M10231
ID
Other
Enumeration date
04/19/2007
Last updated
07/19/2023
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