Bonacquisti, Keith Anthony
Bonacquisti, Keith Anthony is an individual health care provider with primary practice located at 1029 Nichols Rd Ste 301 , Osage Beach MO 65065-3008. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Bonacquisti, Keith Anthony can be contacted via phone (573) 302-2864.Contact Information
Primary practice address
1029 Nichols Rd Ste 301
Osage Beach MO 65065-3008
Phone: (573) 302-2864
Fax: (573) 302-2867
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 036127592 | Illinois |
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 109503 | Missouri |
Profile Details
| NPI number | 1487773669 |
|---|---|
| LBN Legal business name | Bonacquisti, Keith Anthony |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 28th, 2007 |
| Last updated | Sep 24th, 2019 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487773669 | NPPES |
| Missouri | MEDICAID | 208534602 |
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