Provider Demographics
NPI:1790757631
Name:WARREN, KEITH ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ADRIAN
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10100 W 119TH ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1604
Mailing Address - Country:US
Mailing Address - Phone:913-339-6970
Mailing Address - Fax:913-339-6974
Practice Address - Street 1:10100 W 119TH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1604
Practice Address - Country:US
Practice Address - Phone:913-339-6970
Practice Address - Fax:913-339-6974
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-04
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25152207W00000X
MO106616207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS21234042OtherBLUECROSS BLUESHIELD
KS100163470BMedicaid
F48144Medicare UPIN
KST035065Medicare ID - Type Unspecified