Provider Demographics
NPI:1255399754
Name:JOSHUA D WARACH MD SC
Entity type:Organization
Organization Name:JOSHUA D WARACH MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-787-7337
Mailing Address - Street 1:536 N BRUNS LN
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4667
Mailing Address - Country:US
Mailing Address - Phone:217-787-7337
Mailing Address - Fax:217-698-9910
Practice Address - Street 1:536 N BRUNS LN
Practice Address - Street 2:SUITE 2A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4667
Practice Address - Country:US
Practice Address - Phone:217-787-7337
Practice Address - Fax:217-698-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty