Provider Demographics
NPI:1932104106
Name:WARREN, KIMBERLY A (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:WARREN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 WASHINGTON VILLAGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4056
Mailing Address - Country:US
Mailing Address - Phone:937-531-7900
Mailing Address - Fax:937-531-7901
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4056
Practice Address - Country:US
Practice Address - Phone:937-531-7900
Practice Address - Fax:937-531-7901
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4139-W207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720186OtherUNITED HEALTH CARE
OH0882282Medicaid
OH200870OtherNATIONWIDE
OH34004139OtherMEDICAL LICENSE
OH000000227862OtherUNICARE
NDD0413905OtherHUMANA/CHOICECARE
OH421534506072OtherCARESOURCE
OH2916534OtherAETNA
OH160058376OtherRAILROAD MEDICARE
OH000000227862OtherANTHEM
OHH165461Medicare PIN
OH0882282Medicaid
OHH165460Medicare PIN
OHWA0672337Medicare PIN