Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101015058 | MI |
NPI | 1104805944 |
---|---|
Provider Name | Dr. Joseph L. Warren |
First Address | Livonia, MI 48150-3354 |
Second Address | Dearborn, MI 48124-4089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0158213485 | BCBS (01) | MI |
11-4801082 | (05) | MI |
11-4801108 | (05) | MI |
11-4801117 | (05) | MI |
11-4801126 | (05) | MI |
11-4801135 | (05) | MI |
I27085 | (02) | MI |