Provider Demographics
NPI:1992088595
Name:REKHA KOSTECKE, M.D., P.C.
Entity type:Organization
Organization Name:REKHA KOSTECKE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-676-0991
Mailing Address - Street 1:1550 N MILFORD RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1058
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:SUITE 307
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1058
Practice Address - Country:US
Practice Address - Phone:248-676-0991
Practice Address - Fax:248-676-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4078235-10Medicaid
MIH07753Medicare UPIN