Healthcare Provider Details

I. General information

NPI: 1053413914
Provider Name (Legal Business Name): NIKOLA KARLO BARTULICA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FAR WEST DR STE 100
SAINT JOSEPH MO
64506-3514
US

IV. Provider business mailing address

105 FAR WEST DR STE 100
SAINT JOSEPH MO
64506-3514
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-8115
  • Fax: 816-271-8104
Mailing address:
  • Phone: 816-271-8115
  • Fax: 816-271-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007001543
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007001543
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: