Provider Demographics
NPI:1053707638
Name:COSTA, VICTOR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:COSTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5100 W 110TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1215
Mailing Address - Country:US
Mailing Address - Phone:913-345-6960
Mailing Address - Fax:913-345-6966
Practice Address - Street 1:5100 W 110TH ST STE 110
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1215
Practice Address - Country:US
Practice Address - Phone:913-345-6960
Practice Address - Fax:913-345-6966
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10462000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery