Provider Demographics
NPI:1306017991
Name:KOTSONIS, STEVEN MATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MATHER
Last Name:KOTSONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12420 W HAMPTON AVE #89
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-0089
Mailing Address - Country:US
Mailing Address - Phone:262-373-6733
Mailing Address - Fax:262-373-6018
Practice Address - Street 1:1109 CECELIA DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2524
Practice Address - Country:US
Practice Address - Phone:262-373-6733
Practice Address - Fax:262-373-6018
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53437-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100031662Medicaid
K400154177Medicare UPIN