Healthcare Provider Details

I. General information

NPI: 1225659253
Provider Name (Legal Business Name): ANDRIY KOSTYUK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 11TH ST FL 4
INDIANAPOLIS IN
46202-4108
US

IV. Provider business mailing address

3800 RESERVOIR RD NW DEPT OF
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 317-491-6000
  • Fax:
Mailing address:
  • Phone: 202-687-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: