Provider Demographics
NPI:1669449997
Name:GLEED, KENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:GLEED
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 1:2220 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2370
Mailing Address - Country:US
Mailing Address - Phone:785-625-4699
Mailing Address - Fax:785-261-7424
Practice Address - Street 1:2220 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2370
Practice Address - Country:US
Practice Address - Phone:785-625-4699
Practice Address - Fax:785-261-7424
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8837449-1205207R00000X, 207RC0000X, 207RC0001X
NE18763207RC0001X
KS0442895207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06307OtherBS NE
IA1994954Medicaid
IA39995OtherBS IA
IA1994954Medicaid
NE06307OtherBS NE
IAI14691Medicare ID - Type UnspecifiedMEDICARE IA