MEDICARE: ANNA KOSTELANETZ MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	47900-20	WI
2	208000000X	Pediatrics Physician	47900-20	WI
3	208000000X	Pediatrics Physician	47900-020	WI
4	174400000X	Specialist	47900-020	WI

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

General Provider Information

NPI Number	:	1851366611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA KOSTELANETZ MD

Provider Business Mailing Address
First Line	:	3070 N 51ST ST
Second Line	:	SUITE P309
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 W STATE ST APT 432
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-2995
Country	:	US
Telephone Number	:	414-447-7330
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	05/23/2025

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