Provider Demographics
NPI:1235115155
Name:WARNICK, JAMIE SUE (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUE
Last Name:WARNICK
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 1:1770 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3842
Mailing Address - Country:US
Mailing Address - Phone:217-423-8800
Mailing Address - Fax:217-422-8120
Practice Address - Street 1:1770 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3832
Practice Address - Country:US
Practice Address - Phone:217-423-8800
Practice Address - Fax:217-422-8120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7990630OtherAETNA
IL103881OtherHEALTHLINK
IL05832048OtherBLUE CROSS BLUE SHIELD
IL103995OtherHEALTH ALLIANCE
IL2251711OtherCIGNA