Provider Demographics
NPI:1285676940
Name:KOSTECKE, REKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:REKHA
Middle Name:
Last Name:KOSTECKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REKHA
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1550 N MILFORD RD
Mailing Address - Street 2:STE 307
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1022
Mailing Address - Country:US
Mailing Address - Phone:248-676-0991
Mailing Address - Fax:248-676-9862
Practice Address - Street 1:1550 N MILFORD RD
Practice Address - Street 2:STE 307
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1022
Practice Address - Country:US
Practice Address - Phone:248-676-0991
Practice Address - Fax:248-676-9862
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055825208000000X
OH35.140264208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4078235-10Medicaid
MI4301055825OtherLICENSE NUMBER
MI383458615OtherTAX ID
MI4078235-10Medicaid
MI$$$$$$$$$OtherSOCIAL SECURITY NUMBER