Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0531492 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 05-31492 | KS |
NPI | 1164442844 |
---|---|
Provider Name | Matthew G Meschke |
First Address | Andover, KS 67002-8897 |
Second Address | Andover, KS 67002-8897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 14/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200367460C | (05) | KS |
200367460L | (05) | KS |
I50567 | (02) | KS |