Healthcare Provider Details

I. General information

NPI: 1669670501
Provider Name (Legal Business Name): JON GERTKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MOSAIC CT STE 300
SAINT JOSEPH MO
64506-0015
US

IV. Provider business mailing address

101 MOSAIC CT STE 300
SAINT JOSEPH MO
64506-0015
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7673
  • Fax: 816-271-4924
Mailing address:
  • Phone: 816-271-7673
  • Fax: 816-271-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9406867
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number51112
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2012018718
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number04-35006
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: