Provider Demographics
NPI:1043315492
Name:WARREN, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
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 1:6176 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9620
Mailing Address - Country:US
Mailing Address - Phone:231-943-3230
Mailing Address - Fax:231-943-3506
Practice Address - Street 1:6176 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:GRAWN
Practice Address - State:MI
Practice Address - Zip Code:49637-9620
Practice Address - Country:US
Practice Address - Phone:231-943-3230
Practice Address - Fax:231-943-3506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4900367Medicaid