Individual
DR. JON K KOSTELIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1218 SOUTH BROADWAY, SUITE 310, LEXINGTON, KY 40504-2759
(859) 219-0542
(859) 219-9433
Mailing address
1218 SOUTH BROADWAY, SUITE 310, LEXINGTON, KY 40504-2759
(859) 219-0542
(859) 219-9433
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32646
KY
2085R0204X
Vascular & Interventional Radiology Physician
32646
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64326465
—
KY
Enumeration date
04/25/2006
Last updated
03/22/2017
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