Provider Information for 1487947115
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Mr. KEITH STAUCH
Sex: Male
NPI: 1487947115
Last Updated: 2012-07-18
Certification Date:
Certification Date:
Details
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NPI | 1487947115 | ||||||||||||
Enumeration Date | 2011-05-27 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 1301 GALVIN RD S 208 BELLEVUE, NE 68005-3712 United States Phone: 402-860-3405 | Fax: | ||||||||||||
Primary Practice Address | 8610 BRENTWOOD DR 1 LA VISTA, NE 68128-3377 United States Phone: 402-331-3232 | Fax: | ||||||||||||
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