Provider Demographics
NPI:1295004794
Name:ANDERSON, WARREN EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:EDGAR
Last Name:ANDERSON
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 1:1240 GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3638
Mailing Address - Country:US
Mailing Address - Phone:847-295-2149
Mailing Address - Fax:
Practice Address - Street 1:1240 GROVE CT
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3638
Practice Address - Country:US
Practice Address - Phone:847-295-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.040652207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine