Provider Demographics
NPI:1265436729
Name:WARNER, KEITH (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:WARNER
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 1:6100 ROCKSIDE WOODS
Mailing Address - Street 2:SUITE 425
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:STE 219
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6447
Practice Address - Country:US
Practice Address - Phone:440-326-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052130W208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery