Provider Demographics
NPI:1568437713
Name:MUTH, WARREN F (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:F
Last Name:MUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7021 GARRISON CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3447
Mailing Address - Country:US
Mailing Address - Phone:937-434-6334
Mailing Address - Fax:937-534-0340
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2250
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-534-0330
Practice Address - Fax:937-534-0340
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0376445Medicaid
OH0376445Medicaid
OHE54202Medicare UPIN
OHH325140Medicare PIN