Provider Demographics
NPI:1154301760
Name:GLUCK, JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:GLUCK
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 1:7550 WEST VILLAGE CIRCLE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-838-2020
Mailing Address - Fax:316-838-7574
Practice Address - Street 1:7550 WEST VILLAGE CIRCLE
Practice Address - Street 2:SUITE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-838-2020
Practice Address - Fax:316-838-7574
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28516207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100128390AMedicaid
KS024531Medicare ID - Type Unspecified
KS100128390AMedicaid