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Individual

DR. KEITH REYNOLDS WARREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
25 N WINFIELD RD, WINFIELD, IL 60007-3361
(630) 690-4993
(630) 690-2293
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60007-3361
(630) 690-4993
(630) 690-2293

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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