MEDICARE: AARON COSTLOW

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	390200000X	Student in an Organized Health Care Education/Training Program	11021618A	IN
2	207L00000X	Anesthesiology Physician	01095285A	IN

General Provider Information

NPI Number	:	1164008504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON COSTLOW

Provider Business Mailing Address
First Line	:	1130 W MICHIGAN ST # FH204
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-274-0076
Fax Number	:	317-274-0256

Provider Business Practice Location Address
First Line	:	1130 W MICHIGAN ST # FH204
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-274-0076
Fax Number	:	317-274-0256

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	02/02/2026

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