Provider Demographics
NPI:1609105477
Name:HARA, GLENN SHIGEO (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:SHIGEO
Last Name:HARA
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 1:13450 S MOONLIGHT RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-9693
Mailing Address - Country:US
Mailing Address - Phone:913-961-7075
Mailing Address - Fax:
Practice Address - Street 1:13450 S MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9693
Practice Address - Country:US
Practice Address - Phone:913-961-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15456207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology