Doctor Name: | BRIAN COSTELLO |
NPI Number: | 1477982064 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 4916 N Crescent Ave Norridge, IL - 607063108 |
Business Phone Number: | 7084200063 |
Business Fax Number: | |
Mailing Address: | 4916 N Crescent Ave, NORRIDGE |
State: | IL |
Postal Code: | 607063108 |
Phone Number: | 7084200063 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2013 |
NPI Last Update Date: | 11/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |