Provider Demographics
NPI:1316919913
Name:SCHLOTTERBACK, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SCHLOTTERBACK
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 1:1100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-4406
Mailing Address - Country:US
Mailing Address - Phone:620-669-2500
Mailing Address - Fax:620-669-6751
Practice Address - Street 1:1100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-4406
Practice Address - Country:US
Practice Address - Phone:620-669-2500
Practice Address - Fax:620-669-6751
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100135310BMedicaid
KS100135310BMedicaid
KSE90571Medicare UPIN