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General NPI Number Information
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NPI Number | 1366183865
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Entity Type | Individual
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Provider Name | CHRISTIAN GLEN JOHNSON ECK DO
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Gender | Male
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 550 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-4910
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Country | US
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Telephone | 316-962-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 S QUEBEC ST STE 312A
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2208
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Country | US
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Telephone | 303-436-2727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 05-51350
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License Number State | KS
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