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General NPI Number Information
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NPI Number | 1467404640
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Entity Type | Individual
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Provider Name | WARREN K REISS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 921 N LAKE SHORE DR
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City | CULVER
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State | IN
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Zip | 46511-1207
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Country | US
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Telephone | 574-842-3327
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Fax | 574-842-4330
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Provider Business Mailing Address
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Address Line | PO BOX 6309
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City | SOUTH BEND
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State | IN
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Zip | 46660-6309
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Country | US
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Telephone | 574-335-8700
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Fax | 574-335-0760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01026349A
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License Number State | IN
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