Healthcare Provider Details

I. General information

NPI: 1376239111
Provider Name (Legal Business Name): NICHOLAS ANDREW GUTZMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 N BELT HWY
SAINT JOSEPH MO
64506-1211
US

IV. Provider business mailing address

5210 N BELT HWY
SAINT JOSEPH MO
64506-1211
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1330
  • Fax: 816-271-1333
Mailing address:
  • Phone: 816-271-1330
  • Fax: 816-271-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026030355
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: