Provider Demographics
NPI:1265458293
Name:WARNER, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:WARNER
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 1:766 N SUN DR STE 3090
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2555
Mailing Address - Country:US
Mailing Address - Phone:407-863-8700
Mailing Address - Fax:407-264-6877
Practice Address - Street 1:766 N SUN DR STE 3090
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2555
Practice Address - Country:US
Practice Address - Phone:541-561-5373
Practice Address - Fax:407-264-6877
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17533207W00000X
CAC52765207W00000X
FLME123815207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR073155Medicaid
WA1098177OtherDSHS
F80436Medicare UPIN
ORR107054Medicare ID - Type Unspecified
OR073155Medicaid