Ernesto L Acosta, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Appleton, WI
NPI 1386773208 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1386773208
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 24351 (WI)
- Practice address
- 1818 N Meade St
Appleton, WI 54911-3454 - Phone
- (920) 749-4000
- Fax
- (920) 749-4015
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24351 | WI | MD | Obstetrics & Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 24351 | WI | Yes |
Addresses
Primary practice location
1818 N Meade St
Appleton, WI 54911-3454
Mailing address
1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 749-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30439500 | Medicaid | WI |
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All providers in Appleton, WI · Obstetrics & Gynecology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.