Healthcare Provider Details

I. General information

NPI: 1962535997
Provider Name (Legal Business Name): ALEKSANDAR STANIC-KOSTIC MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 DEMING WAY
MIDDLETON WI
53562-0000
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-6160
  • Fax: 608-827-3040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number62613
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number62613
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: