Provider Demographics
NPI:1710916986
Name:WARKENTHIEN, KURT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:JOSEPH
Last Name:WARKENTHIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11019 CANYON RD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4298
Mailing Address - Country:US
Mailing Address - Phone:253-537-0293
Mailing Address - Fax:253-537-7650
Practice Address - Street 1:11019 CANYON RD E
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4298
Practice Address - Country:US
Practice Address - Phone:253-537-0293
Practice Address - Fax:253-537-7650
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080295207Q00000X
WAMD60242443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE19263Medicare UPIN