MEDICARE: PAUL A KOSTAMO M.D.

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	207Q00000X	Family Medicine Physician	ME0053932	FL

General Provider Information

NPI Number	:	1902863236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL A KOSTAMO M.D.

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST STE B
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5710
Country	:	US
Telephone Number	:	305-628-6117
Fax Number	:	305-393-5989

Provider Business Practice Location Address
First Line	:	901 22ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-2933
Country	:	US
Telephone Number	:	727-310-0925
Fax Number	:	727-498-5470

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	01/06/2026

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