MEDICARE: JAMIE SUE WARNICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7990630	OTHER	IL	AETNA
2	103881	OTHER	IL	HEALTHLINK
3	05832048	OTHER	IL	BLUE CROSS BLUE SHIELD
4	103995	OTHER	IL	HEALTH ALLIANCE
5	2251711	OTHER	IL	CIGNA

General Provider Information

NPI Number	:	1235115155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE SUE WARNICK MD

Provider Business Mailing Address
First Line	:	1770 E LAKE SHORE DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-3842
Country	:	US
Telephone Number	:	217-423-8800
Fax Number	:	217-422-8120

Provider Business Practice Location Address
First Line	:	1770 E LAKE SHORE DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-3832
Country	:	US
Telephone Number	:	217-423-8800
Fax Number	:	217-422-8120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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Directions to “ JAMIE SUE WARNICK MD” Practice Location

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