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General NPI Number Information
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NPI Number | 1871519124
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Entity Type | Individual
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Provider Name | JONATHAN WARREN MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3077 W JEFFERSON ST STE 210
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City | JOLIET
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State | IL
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Zip | 60435-5264
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Country | US
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Telephone | 815-773-9090
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Fax | 815-773-9099
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Provider Business Mailing Address
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Address Line | 3077 W JEFFERSON ST STE 210
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City | JOLIET
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State | IL
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Zip | 60435-5264
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Country | US
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Telephone | 815-773-9090
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Fax | 815-773-9099
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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 | 036-104101
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 036104101
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License Number State | IL
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