Provider Demographics
NPI:1275623449
Name:WARONKER, MICHAEL ADAM (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:WARONKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 REECEVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1572
Mailing Address - Country:US
Mailing Address - Phone:610-384-2021
Mailing Address - Fax:610-384-4825
Practice Address - Street 1:217 REECEVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320
Practice Address - Country:US
Practice Address - Phone:610-384-2021
Practice Address - Fax:610-384-4825
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009029L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018025690003Medicaid
PA039059ES4OtherMEDICARE
H19192Medicare UPIN