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
Fax: (573) 302-2867
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487773669 NPPES
Missouri MEDICAID 208534602

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