Healthcare Provider Details

I. General information

NPI: 1699121814
Provider Name (Legal Business Name): MICHAEL WARCUP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 12/17/2021
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 W MAIN ST
VISALIA CA
93291-5731
US

IV. Provider business mailing address

2914 W MAIN ST
VISALIA CA
93291-5731
US

V. Phone/Fax

Practice location:
  • Phone: 596-272-8495
  • Fax: 559-627-9772
Mailing address:
  • Phone: 596-272-8495
  • Fax: 559-627-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5553
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: