MEDICARE: DR. MOLLY M D'COSTA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3463	IA
2	207Q00000X	Family Medicine Physician	036116813	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033199369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY M D'COSTA D.O.

Provider Business Mailing Address
First Line	:	911 N ELM ST
Second Line	:	SUITE 215
City	:	HINSDALE
State	:	IL
Zip	:	60521-3634
Country	:	US
Telephone Number	:	630-856-6820
Fax Number	:	630-856-6810

Provider Business Practice Location Address
First Line	:	2710 111TH STREET
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1189
Country	:	US
Telephone Number	:	630-355-9531
Fax Number	:	630-355-9532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. MOLLY M D'COSTA D.O.” Practice Location

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