| Doctor Name: | PAUL STEPHEN COSTANZO |
| NPI Number: | 1104845239 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 5601003700 |
| Business Practice Address: | 404 Hazen St Suite L3 Paw Paw, MI - 490791040 |
| Business Phone Number: | 2696571595 |
| Business Fax Number: | 2696571534 |
| Mailing Address: | 601 John St, Box 42 KALAMAZOO |
| State: | MI |
| Postal Code: | 490075341 |
| Phone Number: | 2693417806 |
| Fax Number: | 2693418743 |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 09/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601003700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |