| Dominick Joseph Acquaro | |
|
7806 W Jefferson Blvd Ste E Fort Wayne IN 46804-4180 | |
| (260) 459-0087 | |
| (260) 969-8514 |
| Full Name | Dominick Joseph Acquaro |
|---|---|
| Speciality | Family Medicine |
| Location | 7806 W Jefferson Blvd Ste E, Fort Wayne, Indiana |
| Authorized Official Name and Position | Dominick Joseph Acquaro (LEAD CO-OWNER) |
| Authorized Official Contact | 2604590087 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominick Joseph Acquaro 7806 W Jefferson Blvd Ste E Fort Wayne IN 46804-4180 Ph: (260) 459-0087 | Dominick Joseph Acquaro 7806 W Jefferson Blvd Ste E Fort Wayne IN 46804-4180 Ph: (260) 459-0087 |
| NPI Number | 1063276590 |
|---|---|
| Provider Enumeration Date | 02/06/2024 |
| Last Update Date | 02/06/2024 |
| Certification Date | 02/06/2024 |
| Medicare PECOS PAC ID | 2163965948 |
|---|---|
| Medicare Enrollment ID | O20240621000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063276590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Gabrielle Paloma Acquaro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649625104 PECOS PAC ID: 2264723873 Enrollment ID: I20191022002581 |
| Provider Name | Dominick Joseph Acquaro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366930737 PECOS PAC ID: 0749535458 Enrollment ID: I20230302001853 |
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