Provider Demographics
NPI:1588920144
Name:WIRTZ, NICHOLAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:WIRTZ
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 1:5101 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1614
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:6815 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1398
Practice Address - Country:US
Practice Address - Phone:913-721-3387
Practice Address - Fax:816-875-2598
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016643207Y00000X
390200000X
KS04-41067207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program