Provider Demographics
NPI:1487616033
Name:DANIEL G KOSTER MD SC
Entity type:Organization
Organization Name:DANIEL G KOSTER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANHALA-PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-433-3486
Mailing Address - Street 1:704 S WEBSTER AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3528
Mailing Address - Country:US
Mailing Address - Phone:920-433-3486
Mailing Address - Fax:920-433-7994
Practice Address - Street 1:704 S WEBSTER AVE STE 1C
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3528
Practice Address - Country:US
Practice Address - Phone:920-433-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI07007Medicare ID - Type Unspecified