Individual
PHILLIP MARTIN KOSTELIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
237835
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2018
Last updated
07/01/2022
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