Provider Demographics
NPI:1134236565
Name:KAMMERER, WARREN LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:LOUIS
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1440 RENAISSANCE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1356
Mailing Address - Country:US
Mailing Address - Phone:847-296-3442
Mailing Address - Fax:847-296-3543
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-296-3442
Practice Address - Fax:847-296-3543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360778832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077883Medicaid
ILL69200Medicare ID - Type Unspecified
IL036077883Medicaid