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Dr. Joseph Patrick Costello III, MD
Specialist in Swansea, Illinois
NPI 1073607651

Joseph Patrick Costello III is a Specialist based in O Fallon, IL. Joseph Patrick Costello III practices in Swansea, IL and has the professional credentials of MD. The NPI Number for Joseph Patrick Costello III is 1073607651 and holds a License No. 036079559 (Illinois).

The current practice location address for Joseph Patrick Costello III is 4212 N Illinois St, Swansea, IL and can be reached out via phone at 618-233-6685 and via fax at 618-233-6616.

Location: 4212 N Illinois St, Swansea, IL, 62269-0217
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1073607651
Provider Name
Joseph Patrick Costello III
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
4212 N Illinois St, Swansea, IL, 62269-0217
Phone Number
618-233-6685
Fax Number
618-233-6616
Provider Enumeration Date
10/03/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
432064512 01 IL FEDERAL TAX ID
O36079559 05 IL
371390565 01 IL FEDERAL TAX ID
institution
Provider Business Practice Location Address Details
Address
4212 N Illinois St
City
Swansea
State
Illinois
Zip
62226-1835
Phone Number
618-233-6685
Fax Number
618-233-6616
person
Provider Business Mailing Address Details
Address
4212 N Illinois St
City
Swansea
State
Illinois
Zip
62226-1835
Phone Number
618-233-6685
Fax Number
618-233-6616
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
036079559 (Illinois)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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