Provider Demographics
NPI:1093705469
Name:SUTKIN, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:SUTKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 HOLMES ST
Mailing Address - Street 2:STE 800
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2602
Mailing Address - Country:US
Mailing Address - Phone:816-218-2500
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-5181
Practice Address - Fax:816-404-5175
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066077L207V00000X, 207XS0114X
MO2016019905207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125075100Medicaid
NM68370OtherPRESBYTERIAN COMMERCIAL
NM68370Medicaid
TXR0116508OtherDPS
TX106088101Medicaid
TX84338ZOtherHMO BLUE
TX106088103Medicaid
TX8A2704OtherBC/BS
OK100145590AMedicaid
TX125075101OtherFIRSTCARE COMMERCIAL
NMA505OtherTRIWEST
NMB6096Medicaid
TXBS5932430OtherDEA
NMB6096Medicaid
TX125075100Medicaid
NM68370Medicaid