Provider Demographics
NPI:1285636795
Name:HASTINGS, WARREN IAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:IAN
Last Name:HASTINGS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LINCOLN HWY
Mailing Address - Street 2:102
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1862
Mailing Address - Country:US
Mailing Address - Phone:708-747-8994
Mailing Address - Fax:708-747-0170
Practice Address - Street 1:2601 LINCOLN HWY
Practice Address - Street 2:102
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1862
Practice Address - Country:US
Practice Address - Phone:708-747-8994
Practice Address - Fax:708-747-0170
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0060000846OtherBCBS
ILT36918Medicare UPIN
IL521130Medicare PIN