Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036078470 | IL |
N | 111NI0900X | Internist | 036078470 | IL |
N | 207RH0000X | Hematologist | 036078470 | IL |
N | 207RH0003X | Hematology & Oncology | 18369 | WI |
Y | 207RX0202X | Medical Oncology | 036078470 | IL |
NPI | 1013981349 |
---|---|
Provider Name | Dr. Richard F Warren |
First Address | Appleton, WI 54911-5794 |
Second Address | Chicago, IL 60617-3913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001634652 | BCBS - IL (01) | IL |
036078470 | (05) | IL |
1013981349 | NPI - INDIVIDUAL (01) | IL |
1376505065 | NPI - GROUP ( CMGI ) (01) | |
210946 | MEDICARE PROVIDER # (01) | IL |
F59033 | (02) | IL |
P00191109 | RAILROAD - IL (01) | IL |