Provider Demographics
NPI:1649689282
Name:WARREN, ANDREW L (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11475 OLDE CABIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7129
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-569-1787
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:142-516-0313
Practice Address - Fax:314-251-6343
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2023-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK404752085R0202X
KS04470322085R0202X
MO20150037592085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200041908Medicaid
ILENROLLEDMedicaid