Individual
NICHOLAS GOURTZELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10004 KENNERLY RD, STE 374B, ST LOUIS, MO 63128
(314) 842-9669
(314) 842-1017
Mailing address
PO BOX 802841, KANSAS CITY, MO 64180-2841
(314) 842-9669
(314) 842-1017
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
2005006931
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207376708
—
MO
Enumeration date
05/08/2006
Last updated
01/22/2024
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