Healthcare Provider Details

I. General information

NPI: 1487625232
Provider Name (Legal Business Name): ANTONETTE CONSUELO ACOSTA-DICKSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTONETE CONSUELO ACOSTA MD

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 N CHATHAM AVE
KANSAS CITY MO
64151
US

IV. Provider business mailing address

9411 N OAK TRFY SUITE LL1
KANSAS CITY MO
64155-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-741-5542
  • Fax: 816-746-4262
Mailing address:
  • Phone: 816-436-7072
  • Fax: 816-436-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2003017244
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: