1164854220 NPI number — PROF. MARGARET ANN COSTELLO MA, JD, LLP

Table of content: PROF. MARGARET ANN COSTELLO MA, JD, LLP (NPI 1164854220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164854220 NPI number — PROF. MARGARET ANN COSTELLO MA, JD, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSTELLO
Provider First Name:
MARGARET
Provider Middle Name:
ANN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MA, JD, LLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
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Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164854220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15601 ESSEX AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48230-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-596-9854
Provider Business Mailing Address Fax Number:
313-596-9825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17177 NORTH LAUREL PARK; SUITE 131
Provider Second Line Business Practice Location Address:
CRUZ CLINIC
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-462-3210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
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Authorized Official Title or Position:
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Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301002741 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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