Provider Demographics
NPI:1689667685
Name:WATSON, WARREN STEVEN (DMP)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:STEVEN
Last Name:WATSON
Suffix:
Gender:M
Credentials:DMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43050 FORD RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3359
Mailing Address - Country:US
Mailing Address - Phone:734-981-7800
Mailing Address - Fax:734-981-0487
Practice Address - Street 1:43050 FORD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3359
Practice Address - Country:US
Practice Address - Phone:734-981-7800
Practice Address - Fax:734-981-0487
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001518213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2644778Medicaid
MIOM34050001Medicare PIN
MIT11641Medicare UPIN