Provider Demographics
NPI:1245235472
Name:WARNAAR, STUART LEE (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:LEE
Last Name:WARNAAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2345
Mailing Address - Country:US
Mailing Address - Phone:231-252-0068
Mailing Address - Fax:231-935-0613
Practice Address - Street 1:5041 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6986
Practice Address - Country:US
Practice Address - Phone:231-935-0600
Practice Address - Fax:231-935-0613
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4154041Medicaid
MI4154041Medicaid
MIOM85930005Medicare PIN