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1902960149
GERARD T COSTELLO
MUNCIE, IN
NPI
1902960149
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207L00000X Anesthesiology
(Licence: IN 01034732)
Enumeration Date
2006-12-21
Last Update Date
2020-12-28
Business Address
GERARD T COSTELLO MD
2401 UNIVERSITY AVE
MUNCIE, IN 47303
Phone number: 765-741-3111
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Mailing Address
GERARD T COSTELLO MD
1200 W WHITE RIVER BLVD RCS PROVIDER ENROLLMENT
MUNCIE, IN 47303-4988
Phone number: 765-254-4009
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