Healthcare Provider Details

I. General information

NPI: 1497543607
Provider Name (Legal Business Name): THOMAS Z MENGESTEAB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 HOLMES ST
KANSAS CITY MO
64108-2741
US

IV. Provider business mailing address

2411 HOLMES ST
KANSAS CITY MO
64108-2741
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-1789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026025750
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: