Individual
DR. MATTHEW A KIENSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1965 S FREMONT AVE, SUITE 120, SPRINGFIELD, MO 65804-2201
(417) 887-3223
(417) 820-3955
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
2006003278
MO
207YS0123X
Facial Plastic Surgery Physician
Primary
2006003278
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160592001
—
AR
05
—
200586204
—
MO
01
—
204558
MO BLUE SHIELD
MO
01
—
83878
ARK BLUE SHIELD
AR
Enumeration date
02/06/2007
Last updated
05/06/2024
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