MEDICARE: DR. ALEXANDRA M KOSTUR M.D.

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	208000000X	Pediatrics Physician	35-082408	OH
2	208000000X	Pediatrics Physician	ME100724	FL

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	:	1770562464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA M KOSTUR M.D.

Provider Business Mailing Address
First Line	:	7807 BAYMEADOWS RD E STE 207
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9666
Country	:	US
Telephone Number	:	904-446-9991
Fax Number	:	904-446-9992

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E STE 207
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9666
Country	:	US
Telephone Number	:	904-446-9991
Fax Number	:	904-446-9992

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	04/15/2015

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