Individual
MR. KEITH LEOTIS COSBY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8937 THEIS DR, WOODRUFF, WI 54568-9630
(541) 706-1374
Mailing address
8937 THEIS DR, WOODRUFF, WI 54568-9630
(541) 706-1374
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
3747A0650X
WI
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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