Michael J Costello MD PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME0026473 Issued in FL

Legal business name

MICHAEL J COSTELLO MD PA

Practice address

2215 Nebraska Ave
Suite 3-D
Fort Pierce, FL 34950-4864

Phone

(772) 461-4666

Fax

(772) 464-3005

NPI assigned

Oct 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael J Costello, M.D.

Title

President

Phone

(772) 461-4666

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358294400000",
    "number": "1114002995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NEBRASKA AVE",
            "address_2": "SUITE 3-D",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504864",
            "telephone_number": "772-461-4666",
            "fax_number": "772-464-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 NEBRASKA AVE",
            "address_2": "SUITE 3-D",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504864",
            "telephone_number": "772-461-4666",
            "fax_number": "772-464-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J COSTELLO MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2013-01-16",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-461-4666",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME0026473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.