Provider Demographics
NPI:1114993698
Name:FLOERSCH, MATTHEW WADE (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WADE
Last Name:FLOERSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 MONTANA CT
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2328
Mailing Address - Country:US
Mailing Address - Phone:785-539-4100
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:SUITE C-143
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-4940
Practice Address - Fax:785-537-0836
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200347230AMedicaid
KS104993Medicare ID - Type UnspecifiedINDIVIDUAL
KSI42952Medicare UPIN
KS111193Medicare ID - Type UnspecifiedGROUP