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General NPI Number Information
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NPI Number | 1326585001
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Entity Type | Organization
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Legal Business Name | KOSTOROSKI HEALTHCARE
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 18495 S DIXIE HWY SUITE 125
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City | CUTLER BAY
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State | FL
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Zip | 33157-6817
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Country | US
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Telephone | 786-264-2162
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Fax | 786-272-0557
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Provider Business Mailing Address
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Address Line | 18495 S DIXIE HWY SUITE 125
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City | CUTLER BAY
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State | FL
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Zip | 33157-6817
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Country | US
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Telephone | 786-264-2162
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Fax | 786-272-0557
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT KOSTOROSKI
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Credential | D.O.
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Telephone | 786-264-2162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | OS 11923
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License Number State | FL
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