Provider Demographics
NPI:1184637563
Name:KLICK, WARREN E (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:E
Last Name:KLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:BURDETT
Mailing Address - State:NY
Mailing Address - Zip Code:14818-9797
Mailing Address - Country:US
Mailing Address - Phone:607-546-2624
Mailing Address - Fax:
Practice Address - Street 1:3551 COUNTY ROAD 8
Practice Address - Street 2:
Practice Address - City:BURDETT
Practice Address - State:NY
Practice Address - Zip Code:14818-9797
Practice Address - Country:US
Practice Address - Phone:607-546-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170294207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01468024Medicaid
NY01468024Medicaid