MEDICARE: WARREN D. KUIPERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	23525	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578566626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN D. KUIPERS MD

Provider Business Mailing Address
First Line	:	2929 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8034
Country	:	US
Telephone Number	:	602-470-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 S 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3913
Country	:	US
Telephone Number	:	602-344-6600
Fax Number	:	602-344-6601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/12/2015

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