| Organization Name: | COSTELLO PODIATRIC MEDICAL CLINIC |
| NPI Number: | 1053778415 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH COSTELLO (PODIATRIST) |
| Mailing Address: | 1920 Salter Pl Kirksville |
| State: | MO US |
| Postal Code: | 635015165 |
| Phone Number: | 6603420175 |
| Fax Number: | |
| NPI Enumeration Date: | 01/15/2016 |
| NPI Last Update Date: | 01/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 2014003755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |