Provider Demographics
NPI:1518046614
Name:WARNER, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:PLANK ROAD WALK-IN CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-456-7299
Mailing Address - Fax:414-456-6282
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:PLANK ROAD WALK-IN CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-456-7299
Practice Address - Fax:414-456-6282
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518046614Medicaid
WI056U 73-601Medicare PIN
WI1518046614Medicaid
WI68086 0672Medicare PIN