Individual
DR. DENNIS D COSTERISAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
320 E CENTRAL AVE, DECATUR, IL 62521-4665
(217) 877-9117
(217) 877-3078
Mailing address
320 E CENTRAL AVE, DECATUR, IL 62521-4665
(217) 877-9117
(217) 728-2580
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036071025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007005197
BLUE CROSS BLUE SHIELD
IL
05
—
0360710252
—
IL
01
—
080105720
RAILROAD MEDICARE
IL
01
—
178026
HEALTHLINK
IL
Enumeration date
06/01/2005
Last updated
01/25/2022
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