Provider Demographics
NPI:1205839669
Name:WARBASSE, JAMIE K (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:K
Last Name:WARBASSE
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 1:339 SIXTH ST.
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2259
Mailing Address - Country:US
Mailing Address - Phone:231-932-7315
Mailing Address - Fax:
Practice Address - Street 1:1050 SILVER DR.
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2259
Practice Address - Country:US
Practice Address - Phone:231-947-2255
Practice Address - Fax:231-947-5982
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010513652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M86920Medicare ID - Type Unspecified
MIF27402Medicare UPIN