Healthcare Provider Details

I. General information

NPI: 1578566626
Provider Name (Legal Business Name): WARREN D. KUIPERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S 7TH AVE
PHOENIX AZ
85007-3913
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-6600
  • Fax: 602-344-6601
Mailing address:
  • Phone: 602-470-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23525
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: