Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 04-28516 | KS |
NPI | 1154301760 |
---|---|
Provider Name | Mr. James Gluck |
First Address | Wichita, KS 67205 |
Second Address | Wichita, KS 67205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100128390A | (05) | KS |
E56751 | (02) | KS |