Healthcare Provider Details

I. General information

NPI: 1891016333
Provider Name (Legal Business Name): COURTNEY MICHELLE WINTERER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BROADWAY ST 10TH FLOOR
KANSAS CITY MO
64111-2659
US

IV. Provider business mailing address

3101 BROADWAY ST 10TH FLOOR
KANSAS CITY MO
64111-2659
US

V. Phone/Fax

Practice location:
  • Phone: 816-960-2830
  • Fax:
Mailing address:
  • Phone: 816-960-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011036415
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05-36676
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: