Individual
DR. MARISSA KRISTEN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2050 N HAGGERTY RD STE 100, CANTON, MI 48187-3796
(734) 446-9760
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1848
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301509137
MI
207Q00000X
Family Medicine Physician
4352001003
MI
Other
Enumeration date
04/15/2020
Last updated
06/16/2023
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