Healthcare Provider Details

I. General information

NPI: 1639162696
Provider Name (Legal Business Name): CHAJUTA GUSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 6TH AVE SUITE 320
LEAVENWORTH KS
66048-3222
US

IV. Provider business mailing address

PO BOX 12030
OVERLAND PARK KS
66282-2030
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-7705
  • Fax:
Mailing address:
  • Phone: 913-381-9260
  • Fax: 913-383-8336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number22450
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberR-1-J09
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: