Individual
DOMINICK ACQUARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7806 W JEFFERSON BLVD BLDG 2, STE. #C, FORT WAYNE, IN 46804-4179
(260) 459-0087
(260) 969-8514
Mailing address
7806 W JEFFERSON BLVD BLDG 2, STE. #C, FORT WAYNE, IN 46804-4179
(260) 459-0087
(260) 969-8514
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01037315
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000078561
ANTHEM
IN
Enumeration date
08/22/2006
Last updated
07/09/2007
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