Individual
MICHAEL J COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2215 NEBRASKA AVE, SUITE 3D, FORT PIERCE, FL 34950-4864
(772) 461-4666
(772) 464-3005
Mailing address
2215 NEBRASKA AVE, SUITE 3D, FORT PIERCE, FL 34950-4864
(772) 461-4666
(772) 464-3005
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME0026473
FL
2086S0129X
Vascular Surgery Physician
ME0026473
FL
208C00000X
Colon & Rectal Surgery Physician
ME0026473
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021998467
RAILROAD MEDICARE
FL
05
—
056288200
—
FL
01
—
4245215
AETNA
FL
01
—
50734
BLUE CROSS/BLUE SHIELD
FL
Enumeration date
06/29/2006
Last updated
01/23/2013
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