Individual
GLEN J MISKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1947 FOUNDERS ST, WICHITA, KS 67206-3548
(316) 689-9227
(316) 613-4940
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9102
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
27721
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053723
BCBS
KS
01
—
100188
HPK
KS
01
—
11055
PHS
KS
01
—
12149472
MULTIPLAN
KS
01
—
16961
COVENTRY
KS
Enumeration date
06/17/2006
Last updated
07/13/2007
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