| NPI | 1366785610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ALLAN KOSTUSAK President 414-327-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 208VP0000X | |
| 174400000X Specialist | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2013-04-04 |