Provider Demographics
NPI:1225051998
Name:GARR, WARREN RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:RUSSELL
Last Name:GARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1007
Mailing Address - Country:US
Mailing Address - Phone:517-546-0200
Mailing Address - Fax:517-546-3218
Practice Address - Street 1:1200 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1007
Practice Address - Country:US
Practice Address - Phone:517-546-0200
Practice Address - Fax:517-546-3218
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWG041063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101829OtherPREFERRED CHOICES
MI101829OtherCARE CHOICES
MI4040845OtherAETNA
MIB47094OtherHAP
MI1870442Medicaid
MIB6280OtherMCARE
MIP51903OtherBLUE CARE NETWORK
MI700D76226OtherBLUE SHIELD
MIB47094Medicare UPIN
MI101829OtherCARE CHOICES