Provider Demographics
NPI:1902863236
Name:KOSTAMO, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:KOSTAMO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15320 AMBERLY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1647
Mailing Address - Country:US
Mailing Address - Phone:813-977-0733
Mailing Address - Fax:813-971-2230
Practice Address - Street 1:2191 9TH AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:727-327-0990
Practice Address - Fax:727-327-0895
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-08-28
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Provider Licenses
StateLicense IDTaxonomies
FLME0053932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E61840Medicare UPIN
FL07990VMedicare PIN