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General NPI Number Information
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NPI Number | 1952613671
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Entity Type | Individual
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Provider Name | JOSEPH M COSTELLO D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 2121 N BALTIMORE ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-5110
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Country | US
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Telephone | 660-342-0175
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 SALTER PL
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City | KIRKSVILLE
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State | MO
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Zip | 63501-5165
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Country | US
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Telephone |
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Fax |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2014003755
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License Number State | MO
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