Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2007011573 | MO |
NPI | 1013925643 |
---|---|
Provider Name | Matthew T Kneidel |
First Address | Overland Park, KS 66211-1330 |
Second Address | Overland Park, KS 66211-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H65853 | (02) |