Healthcare Provider Details

I. General information

NPI: 1962884585
Provider Name (Legal Business Name): RYAN M VONDERHORST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 RESEARCH PARK DR
MANHATTAN KS
66502-5000
US

IV. Provider business mailing address

1325 RESEARCH PARK DR
MANHATTAN KS
66502-5000
US

V. Phone/Fax

Practice location:
  • Phone: 785-537-2651
  • Fax: 785-270-4347
Mailing address:
  • Phone: 785-537-2651
  • Fax: 785-270-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-39474
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: