Individual
DR. THEODORE ANTHONY KOSTIUK IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
370 N 120TH AVE STE 20, HOLLAND, MI 49424-2196
(616) 396-5855
(616) 396-5720
Mailing address
370 N 120TH AVE STE 20, HOLLAND, MI 49424-2196
(616) 396-5855
(616) 396-5720
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
02004389A
IN
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
5101021584
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201244390
—
IN
Enumeration date
04/07/2009
Last updated
03/04/2019
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