Provider Demographics
NPI:1043252158
Name:WARRICK, BRADLEY K (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:K
Last Name:WARRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 S 4TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5009
Mailing Address - Country:US
Mailing Address - Phone:407-595-8154
Mailing Address - Fax:
Practice Address - Street 1:1202 W FARM RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-2000
Practice Address - Country:US
Practice Address - Phone:405-744-7665
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4340204D00000X, 207QS0010X
KS05-32073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine