Individual
KEITH W VANCURAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1723 BROADWAY ST, SUITE 205, CAPE GIRARDEAU, MO 63701-4566
(573) 331-7930
Mailing address
N62W13520 SUNBURST DR, MENOMONEE FALLS, WI 53051-8335
(573) 331-7930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2008006965
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982760823
—
VA
01
—
2008006965
MISSOURI LICENSE
—
Enumeration date
12/28/2006
Last updated
12/13/2022
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