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General NPI Number Information
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NPI Number | 1598184830
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Entity Type | Individual
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Provider Name | JEFFREY GRANT COSTAIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1185 US HIGHWAY 23 N
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City | ALPENA
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State | MI
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Zip | 49707-8004
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Country | US
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Telephone | 989-356-4049
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Fax | 989-358-3712
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Provider Business Mailing Address
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Address Line | PO BOX 655
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City | ALPENA
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State | MI
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Zip | 49707-0655
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Country | US
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Telephone | 989-356-4049
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Fax | 989-358-3712
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301110985
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License Number State | MI
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