Provider Demographics
NPI:1750559159
Name:WARREN FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:WARREN FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:701-477-8042
Mailing Address - Street 1:1589 SPARTA ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1390
Mailing Address - Country:US
Mailing Address - Phone:701-477-8042
Mailing Address - Fax:
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:SUITE 307
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1390
Practice Address - Country:US
Practice Address - Phone:701-477-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty