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NPI Code Detail

MEDICARE: TIMOTHY ALLEN KOSTUSAK DC

MEDICARE: TIMOTHY ALLEN KOSTUSAK DC
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
1111N00000XChiropractor2888-012WI

General Provider Information

NPI Number : 1679586853
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY ALLEN KOSTUSAK DC
Provider Business Mailing Address
First Line : 6200 W BLUEMOUND RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53213-4145
Country : US
Telephone Number : 414-771-5600
Fax Number : 414-476-9988
Provider Business Practice Location Address
First Line : 6200 W BLUEMOUND RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53213-4145
Country : US
Telephone Number : 414-771-5600
Fax Number : 414-476-9988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 07/08/2007

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Directions to “ TIMOTHY ALLEN KOSTUSAK DC” Practice Location

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