Basic Information
| Provider Information | |||||||||
| NPI: | 1699408021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENTGES | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3023 CAMPBELL ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641091419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363951351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 NW R D MIZE RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640142513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166555403 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2022 | ||||||||
| LastUpdateDate: | 07/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2022025534 | MO | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.