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NPI Code Detail

MEDICARE: MIKE COSTELLO

MEDICARE: MIKE COSTELLO
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1114425543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE COSTELLO
Provider Business Mailing Address
First Line : 2038 PALM ST SPC 41
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4820
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1951 STELLA LAKE ST STE 36
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2144
Country : US
Telephone Number : 702-595-8309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2018
Last Update Date : 01/31/2018

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Directions to “ MIKE COSTELLO ” Practice Location

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