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General NPI Number Information
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NPI Number | 1457880171
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Entity Type | Individual
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Provider Name | ALEXIS WARREN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 1855 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7242
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Country | US
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Telephone | 312-996-6590
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Fax | 312-996-6660
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Provider Business Mailing Address
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Address Line | 150 HARVESTER DR STE 300
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City | BURR RIDGE
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State | IL
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Zip | 60527-5965
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R10912
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | R10912
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036.155464
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License Number State | IL
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