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Individual
WARREN CANNELL
Active
Individual
WARREN CANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036099762
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036099762
—
IL
01
—
047835
HEALTH ALLIANCE MEDICAL
IL
01
—
9815737
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/12/2006
Last updated
07/06/2021
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