Healthcare Provider Details

I. General information

NPI: 1194384008
Provider Name (Legal Business Name): MATTHEW JOSPEH HARTNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15512 W 113TH ST
LENEXA KS
66219-5100
US

IV. Provider business mailing address

15512 W 113TH ST
LENEXA KS
66219-5100
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2522
  • Fax: 816-922-3309
Mailing address:
  • Phone: 816-922-2522
  • Fax: 816-922-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-49604
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: