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Individual
DR. KEITH REYNOLDS WARREN
Active
Individual
DR. KEITH REYNOLDS WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
42-0010962
VT
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
036125979
IL
2084P0800X
Psychiatry Physician
036125979
IL
2084P0800X
Psychiatry Physician
13059
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036125979
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400188615
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
01/30/2006
Last updated
04/15/2015
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