Individual
DR. BLAKE EDWARD KOSTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
744 W 9TH ST, TULSA, OK 74127-9907
(918) 599-1000
Mailing address
12053 MONTER DR, BRIDGETON, MO 63044-2065
(402) 658-1398
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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