Healthcare Provider Details

I. General information

NPI: 1356431001
Provider Name (Legal Business Name): LOUIE KOSTOPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LOUIS KOSTOPOULOS MD

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 840
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number45636
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: