Provider Demographics
NPI:1326113440
Name:PIETTE, WARREN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:WILLIAM
Last Name:PIETTE
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 1:1900 W POLK ST
Mailing Address - Street 2:ADMIN BLDG, 5TH FLOOR, RM 519
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-4478
Mailing Address - Fax:312-864-9663
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:ADMIN BLDG, 5TH FLOOR, RM 519
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-4478
Practice Address - Fax:312-864-9663
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112416207R00000X, 207RH0000X
IL36112416207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA01976Medicare UPIN