Provider Demographics
NPI:1144424847
Name:L ROBERT WARREN MD LLC
Entity Type:Organization
Organization Name:L ROBERT WARREN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:L ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-544-0444
Mailing Address - Street 1:205 CADILLAC CT STE 6
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-1733
Mailing Address - Country:US
Mailing Address - Phone:815-544-0444
Mailing Address - Fax:815-544-0652
Practice Address - Street 1:205 CADILLAC CT STE 6
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-1733
Practice Address - Country:US
Practice Address - Phone:815-544-0444
Practice Address - Fax:815-544-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
209525Medicare ID - Type Unspecified