MEDICARE: MRS. DEBORAH COSTAKOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	41333-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568466928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH COSTAKOS M.D.

Provider Business Mailing Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:	PEDIATRIC OPHTHALMOLOGY
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-607-5280
Fax Number	:	414-266-2027

Provider Business Practice Location Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:	PEDIATRIC OPHTHALMOLOGY
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-607-5280
Fax Number	:	414-266-2027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	03/11/2024

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Directions to “ MRS. DEBORAH COSTAKOS M.D.” Practice Location

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