Individual
CLINTON CHARLES WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5017 GREEN BAY RD STE 148, KENOSHA, WI 53144-1782
(262) 420-5888
(262) 420-5888
Mailing address
5017 GREEN BAY RD STE 148, KENOSHA, WI 53144-1782
(262) 420-5888
(262) 420-5889
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
61666-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902162076
—
WI
Enumeration date
04/03/2012
Last updated
08/10/2022
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