Individual
THEODORA A COSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2333 BIDDLE AVE, WYANDOTTE, MI 48192-4668
(313) 916-1601
Mailing address
2333 BIDDLE AVE, WYANDOTTE, MI 48192-4668
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5151016357
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2023
Last updated
08/17/2023
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