Healthcare Provider Details

I. General information

NPI: 1851633713
Provider Name (Legal Business Name): KYLE JAMES GLIENKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITYPOINT CLINIC-FAMILY MEDICINE-BUENA VISTA 620 NORTHWESTERN DR
STORM LAKE IA
50588-2935
US

IV. Provider business mailing address

PO BOX 1455
DES MOINES IA
50306-1455
US

V. Phone/Fax

Practice location:
  • Phone: 712-732-5030
  • Fax:
Mailing address:
  • Phone: 515-471-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-43865
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-43865
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: