Individual
CAROL COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
801 N STATE ST, GREENFIELD, IN 46140-1270
(317) 468-4415
Mailing address
4685 RELIABLE PKWY, CHICAGO, IL 60686-0001
(317) 802-6301
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01052652
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200311530
—
IN
Enumeration date
10/24/2006
Last updated
01/12/2012
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