Provider Demographics
NPI:1609902790
Name:PETELIN, GINA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:PETELIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:SPALITTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 NE SAINT LUKES BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6001
Mailing Address - Country:US
Mailing Address - Phone:816-282-7809
Mailing Address - Fax:816-282-7870
Practice Address - Street 1:8919 PARALLEL PKWY STE 455
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-3628
Practice Address - Country:US
Practice Address - Phone:913-596-4929
Practice Address - Fax:913-596-4982
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013714207V00000X
KS04-32281207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200425800AMedicaid
MO200425800AMedicaid