Provider Demographics
NPI:1689883514
Name:WARREN, MICHAEL ROY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:WARREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3706
Mailing Address - Country:US
Mailing Address - Phone:888-333-9152
Mailing Address - Fax:763-268-4240
Practice Address - Street 1:3830 SUN CITY CENTER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6820
Practice Address - Country:US
Practice Address - Phone:813-634-5055
Practice Address - Fax:813-634-3988
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3963237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter