Basic Information
Provider Information | |||||||||
NPI: | 1568408532 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUPIN | ||||||||
FirstName: | WARREN | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1450 NW 10TH AVE | ||||||||
Address2: | PO BOX 016960 (M851) | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331361011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052437688 | ||||||||
FaxNumber: | 3052438470 | ||||||||
Practice Location | |||||||||
Address1: | 1450 NW 10TH AVE | ||||||||
Address2: | FIRST FLOOR | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331361011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052436251 | ||||||||
FaxNumber: | 3052433583 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2006 | ||||||||
LastUpdateDate: | 07/24/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | ME79060 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 2587645-00 | 05 | FL |   | MEDICAID |