Individual
DR. FIKISHA LATOYA WARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4857 MANHATTAN DR, ROCKFORD, IL 61108
(815) 708-0116
(815) 708-0174
Mailing address
4857 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 708-0116
(815) 708-0174
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036144365
IL
207Q00000X
Family Medicine Physician
2014024079
MO
207Q00000X
Family Medicine Physician
50745
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036144365
IDFPR
IL
Enumeration date
07/01/2009
Last updated
06/29/2020
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