MEDICARE: LUIZ GUSTAVO MOREIRA COSTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD-48956	IA

General Provider Information

NPI Number	:	1386137446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIZ GUSTAVO MOREIRA COSTA MD

Provider Business Mailing Address
First Line	:	3421 W 9TH ST
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5401
Country	:	US
Telephone Number	:	319-272-5000
Fax Number	:	319-272-5264

Provider Business Practice Location Address
First Line	:	3421 W 9TH ST
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5401
Country	:	US
Telephone Number	:	319-272-5000
Fax Number	:	319-272-5264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	04/10/2026

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Directions to “ LUIZ GUSTAVO MOREIRA COSTA MD” Practice Location

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