MEDICARE: DANIEL G COSTELLO PA

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	363A00000X	Physician Assistant	PA2004-0044	NM
2	363AM0700X	Medical Physician Assistant	2300	CO
3	363AM0700X	Medical Physician Assistant	135562	AK

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

General Provider Information

NPI Number	:	1063415156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL G COSTELLO PA

Provider Business Mailing Address
First Line	:	10543 KENAI SPUR HWY
Second Line	:
City	:	KENAI
State	:	AK
Zip	:	99611-7812
Country	:	US
Telephone Number	:	907-395-0463
Fax Number	:	907-395-0483

Provider Business Practice Location Address
First Line	:	1526 COLE BLVD STE 300
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3410
Country	:	US
Telephone Number	:	303-379-9371
Fax Number	:	303-423-7004

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/07/2025

Similar Medicare Providers

1891798690 — DR. THOMAS MATSUI, D.D.S., P.C.
Practice Location Address:

1526 COLE BLVD , STE 120
LAKEWOOD, CO
80401-3410

Practice Phone: 303-234-0505
Practice Fax: 303-234-0226

1356488639 — DR. ERICK M GOMER MD
Practice Location Address:

1526 COLE BLVD STE 300
LAKEWOOD, CO
80401-3410

Practice Phone: 303-379-9371
Practice Fax: 303-284-4082

1215152848 — DR. THOMAS KENNETH MATSUI DDS
Practice Location Address:

1526 COLE BLVD , #120
LAKEWOOD, CO
80401-3410

Practice Phone: 303-234-0505
Practice Fax: 303-234-0226

1245780949 — MRS. LINDSEY L MOCHEL FNP-C
Practice Location Address:

1526 COLE BLVD STE 300
LAKEWOOD, CO
80401-3410

Practice Phone: 303-379-9371
Practice Fax: 303-284-4082

1235648890 — NATALIA C SPENCER NP
Practice Location Address:

1526 COLE BLVD STE 300
LAKEWOOD, CO
80401-3410

Practice Phone: 303-379-9371
Practice Fax: 303-284-4082

1609321264 — MARISSA LYNN LEWIS
Practice Location Address:

1482 SPRING GARDEN AVE
LAKEWOOD, OH
44107-3410

Practice Phone: 216-527-5016
Practice Fax:

Directions to “ DANIEL G COSTELLO PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.