Organization
GREATER MILWAUKEE PAIN CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ALLAN KOSTUSAK D.C. (PRESIDENT)
(414) 327-6767
Entity
Organization
Contact information
Practice address
10817 W LINCOLN AVE, WEST ALLIS, WI 53227-1127
(414) 327-6767
Mailing address
10817 W LINCOLN AVE, WEST ALLIS, WI 53227-1127
(414) 327-6767
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
04/04/2013
Last updated
04/04/2013
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