Provider Demographics
NPI:1225158694
Name:FIELDS, WARREN BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:BRADLEY
Last Name:FIELDS
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 1:30701 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0990
Mailing Address - Country:US
Mailing Address - Phone:248-548-2114
Mailing Address - Fax:248-548-2135
Practice Address - Street 1:30701 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0990
Practice Address - Country:US
Practice Address - Phone:248-548-2114
Practice Address - Fax:248-548-2135
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121035207RC0200X, 207RP1001X
MI4301076558207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00707900OtherMEDICARE RAILROAD
IL036121035Medicaid
ILR01968Medicare PIN
ILIL2761001Medicare PIN
IL036121035Medicaid