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NPI Code Detail

MEDICARE: KURT JOSEPH WARKENTHIEN M.D.

MEDICARE: KURT JOSEPH WARKENTHIEN M.D.
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
1207Q00000XFamily Medicine Physician036080295IL
2207Q00000XFamily Medicine PhysicianMD60242443WA

General Provider Information

NPI Number : 1710916986
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURT JOSEPH WARKENTHIEN M.D.
Provider Business Mailing Address
First Line : 11019 CANYON RD E
Second Line : SUITE A
City : PUYALLUP
State : WA
Zip : 98373-4298
Country : US
Telephone Number : 253-537-0293
Fax Number : 253-537-7650
Provider Business Practice Location Address
First Line : 11019 CANYON RD E
Second Line : SUITE A
City : PUYALLUP
State : WA
Zip : 98373-4298
Country : US
Telephone Number : 253-537-0293
Fax Number : 253-537-7650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 02/05/2014

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