Provider Demographics
NPI:1831944222
Name:KUSTER-KOSMOSKI, KYMARIE
Entity type:Individual
Prefix:
First Name:KYMARIE
Middle Name:
Last Name:KUSTER-KOSMOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYMARIE
Other - Middle Name:
Other - Last Name:KUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2622 S SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2326
Mailing Address - Country:US
Mailing Address - Phone:612-759-5777
Mailing Address - Fax:
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3678
Practice Address - Country:US
Practice Address - Phone:414-649-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program