Healthcare Provider Details

I. General information

NPI: 1023684487
Provider Name (Legal Business Name): VITTORIA COSTANTINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 METCALF AVE
OVERLAND PARK KS
66213-1324
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 913-296-5000
  • Fax: 913-296-5093
Mailing address:
  • Phone: 816-932-5678
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number04-52704
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: