Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036.060354 | IL |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036060354 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036.060354 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036060354 | IL |
NPI | 1073564860 |
---|---|
Provider Name | Maria Rosa Costanzo |
First Address | Naperville, IL 60540-7430 |
Second Address | Naperville, IL 60540-7430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19272 | (02) |