Individual
MARK P KOSTELAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM, 2400 CANAL STREET, NEW ORLEANS, LA 70119
(504) 784-5364
Mailing address
29 MAGNOLIA TRACE DR, HARVEY, LA 70058-6112
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
PEF.200076
—
Other
Enumeration date
10/15/2020
Last updated
10/15/2020
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