Provider Demographics
NPI:1487625232
Name:ACOSTA-DICKSON, ANTONETTE CONSUELO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONETTE
Middle Name:CONSUELO
Last Name:ACOSTA-DICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANTONETE
Other - Middle Name:CONSUELO
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9411 N OAK TRFY
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-436-7072
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:6450 N CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151
Practice Address - Country:US
Practice Address - Phone:816-741-5542
Practice Address - Fax:816-746-4262
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
33205014OtherBCBS OF KC INDIVIDUAL #
P00134132OtherRAILROAD MEDICARE
H98095Medicare UPIN
MA1960004Medicare PIN