Basic Information
Provider Information
NPI: 1306290812
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GESSOUROUN
FirstName: ANDREW
MiddleName: HURST
NamePrefix: DR.
NameSuffix:  
Credential: M.D., M.ED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3901 RAINBOW BLVD
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608500
CountryCode: US
TelephoneNumber: 9135886670
FaxNumber:  
Practice Location
Address1: 3901 RAINBOW BLVD
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608500
CountryCode: US
TelephoneNumber: 9135886670
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/20/2016
LastUpdateDate: 09/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X04-44858KSN Allopathic & Osteopathic PhysiciansAnesthesiology 
207LC0200X04-44858KSY Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine

No ID Information.


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