Healthcare Provider Details

I. General information

NPI: 1417410705
Provider Name (Legal Business Name): NICOLE FREMAREK DO, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 NE INDEPENDENCE AVE STE 201
LEES SUMMIT MO
64064-2379
US

IV. Provider business mailing address

1750 INDEPENDENCE AVE
KANSAS CITY MO
64106-1453
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2840
  • Fax: 816-525-2841
Mailing address:
  • Phone: 816-654-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2024037892
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2024037892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: