Mark P Kostelak, CCP

Primary specialty

PerfusionistTaxonomy code 242T00000X

License

PEF.200076

Practice address

Southeast Louisiana Veterans Health Care System
2400 Canal Street
New Orleans, LA 70119

Phone

(504) 784-5364

NPI assigned

Oct 15, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1578161105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 MAGNOLIA TRACE DR",
            "city": "HARVEY",
            "state": "LA",
            "postal_code": "700586112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM",
            "address_2": "2400 CANAL STREET",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "70119",
            "telephone_number": "504-784-5364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTELAK",
        "first_name": "MARK",
        "middle_name": "P",
        "credential": "CCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": null,
            "license": "PEF.200076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Mary Korah-Sedgwick, M.D.
• Michelle Denise Korcz, O.D.
• Angela Meredith Kosarek, MD
• Logan J Kosarek, MD
• Kelby Kosel
• Victoria P. Koster, M.D.
• Jennifer A. Kosty, M.D.
• Vikas Kothapalli, MD
• Amrutha Kotlure
• Pamela Jaye Kotorac

• Perfusionist in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Perfusionist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.