Healthcare Provider Details

I. General information

NPI: 1942278106
Provider Name (Legal Business Name): DARYL E WARDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE M124, BRONSON NEUROSCIENCE CENTER
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-7500
  • Fax: 269-341-7540
Mailing address:
  • Phone: 269-341-7500
  • Fax: 269-341-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number18902
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301087085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: