Provider Demographics
NPI:1821099805
Name:KUBINA, GLENN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RICHARD
Last Name:KUBINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:818 N EMPORIA
Mailing Address - Street 2:STE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2193
Mailing Address - Country:US
Mailing Address - Phone:316-263-0296
Mailing Address - Fax:316-684-3326
Practice Address - Street 1:310 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2193
Practice Address - Country:US
Practice Address - Phone:316-684-2838
Practice Address - Fax:316-684-3326
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18133207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200812OtherHEALTH PARTNERS OF KS
4070625OtherAETNA
KS101367OtherBLUE CROSS BLUE SHIELD
1865563004OtherCIGNA
KS504OtherPREFERRED HEALTH SYSTEMS
KS101367OtherWAL-MART
KS504OtherPREFERRED PLUS OF KS
KS200812OtherHEALTH PARTNERS OF KS
4070625OtherAETNA