Healthcare Provider Details

I. General information

NPI: 1982018693
Provider Name (Legal Business Name): WILLIAM GROVER MESSAMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 W VILLAGE CIR STE 1
WICHITA KS
67205-9364
US

IV. Provider business mailing address

7550 W VILLAGE CIR STE 1
WICHITA KS
67205-9364
US

V. Phone/Fax

Practice location:
  • Phone: 316-838-2020
  • Fax: 316-838-7574
Mailing address:
  • Phone: 168-382-0203
  • Fax: 316-838-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number04-42426
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number04-42426
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: