Provider Demographics
NPI:1255341236
Name:ABBOTT, WARREN W (DPM)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:W
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67143
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66667-0143
Mailing Address - Country:US
Mailing Address - Phone:785-273-3500
Mailing Address - Fax:785-273-3515
Practice Address - Street 1:5000 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4510
Practice Address - Country:US
Practice Address - Phone:785-273-3500
Practice Address - Fax:785-273-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200140213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS480922518OtherFEIN
KS826480159OtherRAILROAD MEDICARE ID#
KS826480159OtherRAILROAD MEDICARE ID#
KS006700Medicare ID - Type Unspecified
KS480922518OtherFEIN