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NPI Code Detail

MEDICARE: NICOLAS ALEXANDER KOSTELECKY MBBS

MEDICARE: NICOLAS ALEXANDER KOSTELECKY MBBS
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
1207ZN0500XNeuropathology Physician036.158663IL
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician2019022857MO
3207ZF0201XForensic Pathology Physician4301513424MI

General Provider Information

NPI Number : 1073174140
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLAS ALEXANDER KOSTELECKY MBBS
Provider Business Mailing Address
First Line : 300 PORTAGE ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-4929
Country : US
Telephone Number : 908-666-5797
Fax Number :
Provider Business Practice Location Address
First Line : 300 PORTAGE ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-4929
Country : US
Telephone Number : 908-666-5797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 03/03/2025

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