Healthcare Provider Details

I. General information

NPI: 1073564860
Provider Name (Legal Business Name): MARIA ROSA COSTANZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ROSA COSTANZO NORDIN MD

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST FL 4
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

801 S WASHINGTON ST FL 4
NAPERVILLE IL
60540-7430
US

V. Phone/Fax

Practice location:
  • Phone: 630-600-0700
  • Fax: 630-600-0701
Mailing address:
  • Phone: 630-600-0700
  • Fax: 630-600-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.060354
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036060354
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036060354
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036.060354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: