MEDICARE: DR. REKHA KOSTECKE M.D

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
1	208000000X	Pediatrics Physician	4301055825	MI
2	208000000X	Pediatrics Physician	35.140264	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4301055825	OTHER	MI	LICENSE NUMBER
3	383458615	OTHER	MI	TAX ID

General Provider Information

NPI Number	:	1285676940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REKHA KOSTECKE M.D

Provider Business Mailing Address
First Line	:	1550 N MILFORD RD
Second Line	:	STE 307
City	:	MILFORD
State	:	MI
Zip	:	48381-1022
Country	:	US
Telephone Number	:	248-676-0991
Fax Number	:	248-676-9862

Provider Business Practice Location Address
First Line	:	1550 N MILFORD RD
Second Line	:	STE 307
City	:	MILFORD
State	:	MI
Zip	:	48381-1022
Country	:	US
Telephone Number	:	248-676-0991
Fax Number	:	248-676-9862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	06/15/2022

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