Image, Ear, Nose & Throat Surgery, Inc.

NPI #1689992398 in Festus, Missouri

Provider Information

NPI Number: 1689992398
Entity Type: Organization
Organization Name: Image, Ear, Nose & Throat Surgery, Inc.
Primary Specialty: Otolaryngology
Enumeration Date: May 6, 2010
Last Updated: May 14, 2010

Practice Location

Address: 1151 GANNON DRIVE EAST
City: Festus
State: Missouri
ZIP Code: 63028-2611
Phone: (636) 937-2388

Authorized Official

Name: KEITH A. BONACQUISTI, MD
Title: PRESIDENT
Phone: (636) 937-2388

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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