Provider Demographics
NPI:1346272598
Name:VONROENN, WARREN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:GREGORY
Last Name:VONROENN
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 1:11101 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1133
Mailing Address - Country:US
Mailing Address - Phone:414-327-3000
Mailing Address - Fax:
Practice Address - Street 1:11101 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1133
Practice Address - Country:US
Practice Address - Phone:414-203-4491
Practice Address - Fax:414-203-4526
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00451311OtherRR MEDICARE
WI30919300Medicaid
WI30919300Medicaid
B85336Medicare UPIN
WIP00451311OtherRR MEDICARE
WI46236-0144Medicare PIN
WI01994-0144Medicare PIN