Individual
NICHOLAS P COSTIDAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2606 VETERANS MEMORIAL PKWY S STE 8, LAFAYETTE, IN 47909-9192
(765) 447-4776
(765) 447-4809
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000748A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000247376
ANTHEM PROVIDER NUMBER
IN
05
—
100232960
—
IN
01
—
10781139
CAQH
IN
01
—
480034530
MEDICARE RAILROAD NUMBER
IN
Enumeration date
03/11/2006
Last updated
03/22/2021
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