PAUL STEPHEN COSTANZO (NPI# 1104845239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104845239 |
| Entity Type | Individual |
| Full Name | PAUL STEPHEN COSTANZO |
| Credential | PA-C |
| Practice Address |
404 Hazen St Suite L3 Paw Paw MI 49079-1040 |
| Mailing Address |
601 John St Box 42 Kalamazoo MI 49007-5341 |
| Practice Telephone | 2696571595 |
| Practice Fax Number | 2696571534 |
| Mailing Telephone | 2693417806 |
| Mailing Fax Number | 2693418743 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2010-09-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601003700 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM | 0H060020 | 01 |
| Street Address |
404 HAZEN ST SUITE L3 |
| City | PAW PAW |
| State | MI |
| Zip Code | 49079-1040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437159597 | Nadeem M Mirza | Psychiatry & Neurology | 404 Hazen St, Suite 104, Paw Paw, MI 49079-1040 | 2005-07-29 |
| 1346510252 | Lisa Rae Woodruff | Nurse Practitioner | 404 Hazen St, Suite L3, Paw Paw, MI 49079-1040 | 2012-01-09 |
| 1639313174 | Bronson Lakeview Hospital | Psychologist | 404 Hazen St, Suite L3, Paw Paw, MI 49079-1040 | 2009-04-28 |
| 1477762441 | Rebecca L Thoreson | Surgery | 404 Hazen St, Suite 101, Paw Paw, MI 49079-1040 | 2007-05-22 |
| 1265656086 | Lakeview Community Hospital Authority | Surgery | 404 Hazen St, Suite 101, Paw Paw, MI 49079-1040 | 2007-04-12 |
| 1881706273 | Michael Kruk | Social Worker | 404 Hazen St, Suite L3, Paw Paw, MI 49079-1040 | 2006-08-31 |
| 1427161314 | Barbara L Thompson | Pharmacist | 404 Hazen St, Suite 102, Paw Paw, MI 49079-1040 | 2006-08-16 |
| 1710090519 | Jennifer L Sampsell | Pharmacy Technician | 404 Hazen St, Suite 102, Paw Paw, MI 49079-1040 | 2006-08-16 |
| 1376554881 | Skinner & Hang Inc | Pharmacy | 404 Hazen St, Suite 102, Paw Paw, MI 49079-1040 | 2006-08-10 |
| 1043228174 | Patrick Michael Lynch | Pharmacist | 404 Hazen St, Suite 102, Paw Paw, MI 49079-1040 | 2006-08-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700359387 | Elizabeth Ann Heskett | Social Worker | Bronson Lakeview Family Care, 451 Health Parkway, Suite B, Paw Paw, MI 49079 | 2019-01-07 |
| 1346775269 | Timothy Adli Kanaan | Counselor | 816 E Michigan Ave Ste 103, Paw Paw, MI 49079 | 2017-04-28 |
| 1558655464 | Tamayi Bwititi | Family Medicine | 451 Health Pkwy Ste G, Paw Paw, MI 49079 | 2011-06-08 |
| 1942401047 | Jenny Adina Grunberg | Dentist | 54055 County Rd 653, Paw Paw, MI 49079 | 2007-05-29 |
| 1912058918 | David James Potts | Psychologist | 181 West Michigan Ave Suite 3, Mapleview Consultation Center P.c, Paw Paw, MI 49079 | 2007-01-16 |
| 1760438378 | Starhealth Multi-specialty Group, P.C. Pharmacy | Pharmacist | 451 Health Parkway, Paw Paw, MI 49079 | 2006-05-25 |
| 1528029568 | Jayantilal J Bathani | Pediatrics | 505 Hazen St, Ste 203, Paw Paw, MI 49079 | 2006-03-29 |
| 1548231202 | Gregory Cassidy | Physician Assistant | 125 N Kalamazoo St, #82, Paw Paw, MI 49079 | 2006-01-31 |
| 1649782418 | Amber Bemis | Occupational Therapy Assistant | 801 Hazen Street, Suite C, Paw Paw, MI 49079 | 2017-11-01 |
| 1073047122 | Theresa Arnold | Social Worker | 181 W Michigan Ave Ste 3, Paw Paw, MI 49079 | 2017-04-15 |
| Find all providers in zip 49079 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811048101 | Gregory Robert Hughes | Physician Assistant | 451 Health Pkwy, Paw Paw, MI 49079-8242 | 2007-01-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616687 | Alexandria Jaclyn Miller | Physician Assistant | 4700 Chipman Dr, Waterford, MI 48327-3413 | 2020-10-15 |
| 1639777287 | Piotr Z Purzycki | Physician Assistant | 41400 Dequindre Rd Ste 101, Sterling Heights, MI 48314-3751 | 2020-10-15 |
| 1013524859 | Amber Marie Lee | Physician Assistant | 2265 South Lindenroad, Suite A, Flint, MI 48532 | 2020-09-25 |
| 1326656844 | Dominic Farrell | Physician Assistant | 224 Portchester Rd, Holland, MI 49424-2628 | 2020-07-21 |
| 1982212072 | Alexandria Bower-nelson | Physician Assistant | 1302 Porter Drive, Charlotte, MI 48813 | 2020-07-15 |
| 1013535343 | Maria Pavia | Physician Assistant | 41302 Scarborough Ln, Novi, MI 48375-2893 | 2020-07-13 |
| 1073130241 | Kelly F Esper | Physician Assistant | 9043 Glenwood Ln, Northville, MI 48168-9129 | 2020-07-02 |
| 1811513971 | Tasha Baker | Physician Assistant | 5444 E Whitefeather Rd, Pinconning, MI 48650-8407 | 2020-06-24 |
| 1437770054 | Sterling Ryan Maxfield | Physician Assistant | 6187 Oak Grove Rd, Howell, MI 48855-8247 | 2020-05-05 |
| 1760018808 | Rachel Renee Mackmin | Physician Assistant | 41498 Mary Kay Dr, Clinton Township, MI 48038-1989 | 2020-03-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.