MEDICARE: DR. SUSAN KAY WARDEN MD

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
1	208100000X	Physical Medicine & Rehabilitation Physician	H7102	TX

General Provider Information

NPI Number	:	1255480604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN KAY WARDEN MD

Provider Business Mailing Address
First Line	:	5905 COLHURST ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5905 COLHURST ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5021
Country	:	US
Telephone Number	:	214-691-9939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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