Individual
DR. AGNES KATHERINE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-6631
(630) 933-4936
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-6631
(630) 933-4936
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036117700
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117700
—
IL
01
—
206147
MEDICARE (GROUP)
IL
01
—
206147218
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
07/28/2008
Last updated
12/02/2013
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