=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790757631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH ADRIAN WARREN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2006
-----------------------------------------------------
Last Update Date | 12/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10100 W 119TH ST SUITE 260
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66213-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-339-6970
-----------------------------------------------------
Fax | 913-339-6974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10100 W 119TH ST SUITE 260
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66213-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-339-6970
-----------------------------------------------------
Fax | 913-339-6974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 04-25152
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 106616
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------