Provider Demographics
NPI:1518144336
Name:ALAN R. WARREN, D.P.M.
Entity Type:Organization
Organization Name:ALAN R. WARREN, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-778-0400
Mailing Address - Street 1:24836 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1241
Mailing Address - Country:US
Mailing Address - Phone:586-778-0400
Mailing Address - Fax:586-778-5263
Practice Address - Street 1:24836 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1241
Practice Address - Country:US
Practice Address - Phone:586-778-0400
Practice Address - Fax:586-778-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAW400236213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2651870Medicaid
MI4855053930OtherBLUE CROSS BLUE SHIELD
MI2651870Medicaid
MI0M33550Medicare PIN
MIT34203Medicare UPIN