Theodora A Costin, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

5151016357 Issued in MI

Practice address

2333 Biddle Ave
Wyandotte, MI 48192-4668

Phone

(313) 916-1601

NPI assigned

Apr 26, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: tcostin851467@direct.hfhs.org

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

{
    "created_epoch": "1682467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1609564715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "313-916-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTIN",
        "first_name": "THEODORA",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5151016357",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne G Compo, DO
• Conquest Pain Management, LLC
• Debra Marie Consiglio, NP
• Amy Sue Cooper, PHARMACY TECHNICIAN
• Mary Ann Corneliussen, MSW
• Kelsey Cretens, PT
• Kayla Cribbin
• Dax Marquez Crisostomo, PT
• D. Bradford Barker, MD, PLC
• Aya H Dabaja, DO

• Obstetrics & Gynecology Physician in Wyandotte, MI
• Providers in Wyandotte, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.