Healthcare Provider Details

I. General information

NPI: 1013088277
Provider Name (Legal Business Name): KOSTANDINOS TSOULFAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10105 74TH ST
KENOSHA WI
53142-7510
US

IV. Provider business mailing address

2500 W LAYTON AVE STE 200
MILWAUKEE WI
53221-5434
US

V. Phone/Fax

Practice location:
  • Phone: 262-297-7246
  • Fax: 888-714-0578
Mailing address:
  • Phone: 262-297-7246
  • Fax: 888-714-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number49097-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49097
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: