Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME57582 | FL |
NPI | 1134128481 |
---|---|
Provider Name | Eugene Norman Costantini |
First Address | Ft Lauderdale, FL 33316-2517 |
Second Address | Ft Lauderdale, FL 33316-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 05/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063842100 | (05) | FL |
E92492 | (02) | FL |