1578566626 NPI number — WARREN D. KUIPERS MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	KUIPERS
Provider First Name	:	WARREN
Provider Middle Name	:	D.
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

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Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
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Provider Other Credential Text	:
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NPI Number	:	1578566626
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	08/20/2008
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	8620 N 22ND AVE
Provider Second Line Business Mailing Address	:	200
Provider Business Mailing Address City Name	:	PHOENIX
Provider Business Mailing Address State Name	:	AZ
Provider Business Mailing Address Postal Code	:	850214251
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	6026746506
Provider Business Mailing Address Fax Number	:	6026746512

Provider First Line Business Practice Location Address	:	4524 N MARYVALE PKWY
Provider Second Line Business Practice Location Address	:	STE 120
Provider Business Practice Location Address City Name	:	PHOENIX
Provider Business Practice Location Address State Name	:	AZ
Provider Business Practice Location Address Postal Code	:	85031
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6238484460
Provider Business Practice Location Address Fax Number	:	6238484485
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
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• Taxonomy code: 207Q00000X , with the licence number:  23525 , registered in the state of AZ .

• Identifier: 325052 , issued by the state of ( AZ ) . This identifiers is of the category "".
• Identifier: Z74867 , issued by the state of ( AZ ) . This identifiers is of the category "".
• Identifier: D57473 . This identifiers is of the category "".