Paul Stephen Costanzo, PA-C
Physician Assistant, Medical in Paw Paw, MI. Individual provider (NPI-1).
NPI number1104845239
StatusActive
Last updated in NPPESSep 27, 2010
Details
- NPI
- 1104845239
- Entity type
- Individual (NPI-1)
- Name
- Paul Stephen Costanzo
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 19, 2006
- Last updated
- Sep 27, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 5601003700 | MI | Yes |
Practice location
404 Hazen StSuite L3
Paw Paw, MI 49079-1040
Phone 269-657-1595 · Fax 269-657-1534
Mailing address
601 John StBox 42
Kalamazoo, MI 49007-5341
Phone 269-341-7806 · Fax 269-341-8743
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