Provider Demographics
NPI:1144236167
Name:GLASS, CYNTHIA J (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR
Mailing Address - Street 2:SUITE 220 ADMINISTRATION
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:816-942-8200
Mailing Address - Fax:913-495-3760
Practice Address - Street 1:373 W 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4408
Practice Address - Country:US
Practice Address - Phone:816-942-8200
Practice Address - Fax:913-495-3760
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B70207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK676141Medicare PIN
MO110231647Medicare PIN
C51343Medicare UPIN