Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 04-18115 | KS |
NPI | 1174522445 |
---|---|
Provider Name | Edward Philip Gutek |
First Address | Leawood, KS 66211-1454 |
Second Address | Leawood, KS 66211-1454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05177012 | BLUE CROSS BLUE SHIELD (01) | KS |
D93759 | (02) |