Healthcare Provider Details

I. General information

NPI: 1578725479
Provider Name (Legal Business Name): WARREN KAMMERER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RENAISSANCE DR SUITE 200
PARK RIDGE IL
60068-1472
US

IV. Provider business mailing address

1440 RENAISSANCE DR SUITE 200
PARK RIDGE IL
60068-1472
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-3442
  • Fax: 847-296-3543
Mailing address:
  • Phone: 847-296-3442
  • Fax: 847-296-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036077883
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number036077883
License Number StateIL

VIII. Authorized Official

Name: DR. WARREN LOUIS KAMMERER III
Title or Position: PRESIDENT
Credential: MD
Phone: 847-296-3442