Healthcare Provider Details

I. General information

NPI: 1912986506
Provider Name (Legal Business Name): WILLIAM CHRIS KOSTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 OLD OLIVE ST RD STE 200
CREVE COEUR MO
63141
US

IV. Provider business mailing address

10448 OLD OLIVE STREET RD
CREVE COEUR MO
63141-5967
US

V. Phone/Fax

Practice location:
  • Phone: 314-597-8887
  • Fax: 314-447-9559
Mailing address:
  • Phone: 314-966-8887
  • Fax: 314-966-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number113686
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: