Provider Demographics
NPI:1477599603
Name:COSTA, DENNIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:COSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2400 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-847-2022
Mailing Address - Fax:715-847-2775
Practice Address - Street 1:2400 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-847-2022
Practice Address - Fax:715-847-2775
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1724-850208600000X
WI498442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery