Healthcare Provider Details

I. General information

NPI: 1851366611
Provider Name (Legal Business Name): ANNA KOSTELANETZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 W STATE ST APT 432
MILWAUKEE WI
53213-2995
US

IV. Provider business mailing address

3070 N 51ST ST SUITE P309
MILWAUKEE WI
53210-1645
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-7330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number47900-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47900-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47900-020
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number47900-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: