Provider Demographics
NPI:1033100813
Name:WARREN, ALAN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:WARREN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24836 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1241
Mailing Address - Country:US
Mailing Address - Phone:586-778-0400
Mailing Address - Fax:586-778-5263
Practice Address - Street 1:24836 HARPER AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1241
Practice Address - Country:US
Practice Address - Phone:586-778-0400
Practice Address - Fax:586-778-5263
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAW400236213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4855053930OtherBLUE CROSS BLUE SHIELD
MI2651870Medicaid
T34203Medicare UPIN
MI0M33550Medicare PIN
MI2651870Medicaid