Individual
DR. PATRICK T. COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
933 E PIERCE ST, COUNCIL BLUFFS, IA 51503-4626
(712) 396-6111
(712) 396-7026
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
32065
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1505750
—
IA
05
—
42068035512
—
NE
Enumeration date
08/18/2006
Last updated
12/16/2013
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