Provider Demographics
NPI:1285716613
Name:GLUHOVSKY, GLEB (PA-C)
Entity type:Individual
Prefix:MR
First Name:GLEB
Middle Name:
Last Name:GLUHOVSKY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24051 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6231
Mailing Address - Country:US
Mailing Address - Phone:913-486-6530
Mailing Address - Fax:
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2373
Practice Address - Country:US
Practice Address - Phone:913-541-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ51830Medicare UPIN
KSR86E116BMedicare ID - Type UnspecifiedMEDICARE