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NPI Code Detail

MEDICARE: DR. BRADLEY K WARRICK DO

MEDICARE: DR. BRADLEY K WARRICK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204D00000XNeuromusculoskeletal Medicine & OMM Physician4340OK
2207QS0010XSports Medicine (Family Medicine) Physician4340OK
3207Q00000XFamily Medicine Physician05-32073KS

General Provider Information

NPI Number : 1043252158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY K WARRICK DO
Provider Business Mailing Address
First Line : 3550 S 4TH ST
Second Line : STE 200
City : LEAVENWORTH
State : KS
Zip : 66048-5009
Country : US
Telephone Number : 407-595-8154
Fax Number :
Provider Business Practice Location Address
First Line : 1202 W FARM RD
Second Line :
City : STILLWATER
State : OK
Zip : 74078-2000
Country : US
Telephone Number : 405-744-7665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 05/29/2018

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