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Individual

DR. MARCO A COSTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3666
Mailing address
10000 W INNOVATION DR, MILWAUKEE, WI 53226-4837
(414) 456-5006
(414) 456-6259

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
30434
KY
207R00000X
Internal Medicine Physician
Primary
50996
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1851477913
CMH NPI
WI
Enumeration date
05/19/2006
Last updated
12/07/2010
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