Healthcare Provider Details

I. General information

NPI: 1730961830
Provider Name (Legal Business Name): MOKAN WEIGHT LOSS AND METABOLIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W 83RD ST STE 135
PRAIRIE VILLAGE KS
66208-5323
US

IV. Provider business mailing address

4121 W 83RD ST STE 135
PRAIRIE VILLAGE KS
66208-5323
US

V. Phone/Fax

Practice location:
  • Phone: 913-303-1165
  • Fax:
Mailing address:
  • Phone: 913-303-1165
  • Fax: 800-816-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW LINDQUIST
Title or Position: OWNER
Credential: DO
Phone: 913-303-1165