Healthcare Provider Details

I. General information

NPI: 1760475131
Provider Name (Legal Business Name): DAVID WARREN LAW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19117 ALLEN RD STE A
BROWNSTOWN TWP MI
48183-1066
US

IV. Provider business mailing address

20952 E 12 MILE RD SUITE 200
SAINT CLAIR SHORES MI
48081-3200
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-4040
  • Fax: 734-676-9897
Mailing address:
  • Phone: 586-771-4820
  • Fax: 586-771-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number51010O7204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: