Provider Demographics
NPI:1487622395
Name:KOSLOV, STEVEN S (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:KOSLOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 BOUNDARY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3831
Mailing Address - Country:US
Mailing Address - Phone:608-836-6059
Mailing Address - Fax:
Practice Address - Street 1:1365 BOUNDARY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3831
Practice Address - Country:US
Practice Address - Phone:608-836-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics