Individual
DR. JOSEPH KOSTESICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
51950 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48316-4453
(586) 254-9030
Mailing address
51950 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48316-4453
(586) 254-9030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002753
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06638
MEDICARE PTAN
MI
Enumeration date
08/18/2005
Last updated
02/17/2015
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