Healthcare Provider Details

I. General information

NPI: 1871098467
Provider Name (Legal Business Name): MATTHEW RYAN LOUIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 N HILLSIDE ST STE 550
WICHITA KS
67214-4928
US

IV. Provider business mailing address

551 N HILLSIDE ST STE 550
WICHITA KS
67214-4928
US

V. Phone/Fax

Practice location:
  • Phone: 316-235-3933
  • Fax: 844-670-8666
Mailing address:
  • Phone: 316-235-3933
  • Fax: 844-670-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD89299
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number04-50753
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: