Provider Demographics
NPI:1902993603
Name:WARREN, ANN T (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:T
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25941 N FARM VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7022
Mailing Address - Country:US
Mailing Address - Phone:847-381-5104
Mailing Address - Fax:847-381-0604
Practice Address - Street 1:27790 W IL ROUTE 22 STE 32
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2396
Practice Address - Country:US
Practice Address - Phone:847-381-8181
Practice Address - Fax:847-381-0604
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075414174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075414Medicaid
IL04915108OtherBLUECROSS/BLUESHIELD
ILL66064Medicare ID - Type UnspecifiedMEDICARE
ILE18391Medicare UPIN