Provider Demographics
NPI:1568408532
Name:KUPIN, WARREN L (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:L
Last Name:KUPIN
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 1:1450 NW 10TH AVE
Mailing Address - Street 2:PO BOX 016960 (M851)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1011
Mailing Address - Country:US
Mailing Address - Phone:305-243-7688
Mailing Address - Fax:305-243-8470
Practice Address - Street 1:1450 NW 10TH AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1011
Practice Address - Country:US
Practice Address - Phone:305-243-6251
Practice Address - Fax:305-243-3583
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79060207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2587645-00Medicaid
FL2587645-00Medicaid
49149Medicare ID - Type Unspecified