Provider Demographics
NPI:1356457006
Name:MACKAY, GLENN (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:MACKAY
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 1:5701 STATE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1281
Mailing Address - Country:US
Mailing Address - Phone:913-287-7800
Mailing Address - Fax:913-287-1112
Practice Address - Street 1:5701 STATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1281
Practice Address - Country:US
Practice Address - Phone:913-287-7800
Practice Address - Fax:913-287-1112
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0427706207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100391820CMedicaid
KS100391820BMedicaid
KS100391820CMedicaid
KSH35563Medicare UPIN