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Individual

DR. COSTA H SOUSOU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1212 WELL ST, ONALASKA, WI 54650-2668
(608) 785-0940
Mailing address
PO BOX 1510, EAU CLAIRE, WI 54702-1510

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
54770
MN
207V00000X
Obstetrics & Gynecology Physician
54981
WI
207V00000X
Obstetrics & Gynecology Physician
Primary
CP209585
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100011679
WI
Enumeration date
06/10/2005
Last updated
01/25/2024
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