Healthcare Provider Details

I. General information

NPI: 1437470127
Provider Name (Legal Business Name): MR. JAMES KOSTOWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 NORTH KENDALL DRIVE
MIAMI FL
33176
US

IV. Provider business mailing address

8900 NORTH KENDALL DRIVE
MIAMI FL
33176
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-1960
  • Fax:
Mailing address:
  • Phone: 786-596-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9251840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: