Healthcare Provider Details

I. General information

NPI: 1356457006
Provider Name (Legal Business Name): GLENN MACKAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7255 RENNER RD STE 100
SHAWNEE KS
66217-3101
US

IV. Provider business mailing address

7255 RENNER RD STE 100
SHAWNEE KS
66217-3101
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-0405
  • Fax: 913-631-0409
Mailing address:
  • Phone: 913-631-0405
  • Fax: 913-631-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0427706
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: