Individual
REBEKAH COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3400 MARKET LN, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 551-4630
Mailing address
3400 MARKET LN, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 653-5850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036.144957
IL
207Q00000X
Family Medicine Physician
05775
KY
207Q00000X
Family Medicine Physician
Primary
71089-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.144957
ILLINOIS MEDICAL LICENSE
IL
05
—
1326452921
—
WI
Enumeration date
06/12/2014
Last updated
06/06/2024
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