MEDICARE: DR. GINA MARIE PETELIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	04-32281	KS
2	207V00000X	Obstetrics & Gynecology Physician	2009013714	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609902790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA MARIE PETELIN M.D.

Provider Business Mailing Address
First Line	:	20 NE SAINT LUKES BLVD
Second Line	:	SUITE 310
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-6001
Country	:	US
Telephone Number	:	816-282-7809
Fax Number	:	816-282-7870

Provider Business Practice Location Address
First Line	:	8919 PARALLEL PKWY STE 455
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-3628
Country	:	US
Telephone Number	:	913-596-4929
Fax Number	:	913-596-4982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	11/17/2025

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