Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
PETRONILO R COSTA, MD
Active Sole Proprietor2083P0011X · DEERFIELD, IL
Registration Details
- NPI Number
- 1043435340
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 13, 2007 (19.025738976314 yrs)
- Last Updated
- Oct 12, 2016
- Licenses
-
036-046-108 (IL)036-046-108 (IL)036-046-108 (IL)036-046-108 (IL)036-046-108 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
420 LAKE COOK RD STE 118DEERFIELD, IL, 600154914Browse IL providers · Browse ZIP 60015
- Phone
- 8472050237
- Fax
- 8667353898
- Primary Specialty
-
2083P0011X
2083P0011X
- Additional Specialty
- Pediatrics
- Additional Specialty
- Adolescent Medicine (Pediatrics)
- Additional Specialty
- Developmental-Behavioral Pediatrics
- Additional Specialty
- Neurodevelopmental Disabilities
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.