Provider Demographics
NPI:1245202787
Name:CUSTER, GALEN M (MD)
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:M
Last Name:CUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9200 INDIAN CREEK PKWY
Mailing Address - Street 2:BUILDING 9, SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2002
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:12200 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4045
Practice Address - Country:US
Practice Address - Phone:913-574-2650
Practice Address - Fax:913-574-2769
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24997207RH0003X
MO101826207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245202787Medicaid
KS100192750CMedicaid
KSP00953195Medicare PIN
KSK40000056Medicare PIN
KS100192750CMedicaid