Healthcare Provider Details

I. General information

NPI: 1164442844
Provider Name (Legal Business Name): MATTHEW G MESCHKE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 KEYSTONE CIR
ANDOVER KS
67002-8749
US

IV. Provider business mailing address

2117 KEYSTONE CIR
ANDOVER KS
67002-8749
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-5120
  • Fax: 316-733-1280
Mailing address:
  • Phone: 316-733-5120
  • Fax: 316-733-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number05-31492
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0531492
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: