Healthcare Provider Details

I. General information

NPI: 1265436729
Provider Name (Legal Business Name): KEITH WARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROAD ST STE 219
ELYRIA OH
44035-6447
US

IV. Provider business mailing address

6100 ROCKSIDE WOODS SUITE 425
INDEPENDENCE OH
44131-2366
US

V. Phone/Fax

Practice location:
  • Phone: 440-326-5250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35052130W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: