Provider Demographics
NPI:1366436016
Name:SVOBODA, MATTHEW JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3722
Mailing Address - Country:US
Mailing Address - Phone:913-661-9980
Mailing Address - Fax:913-661-9173
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-661-9980
Practice Address - Fax:913-661-9173
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1060269363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02303Medicare UPIN
KS638C764Medicare PIN