MEDICARE: ALEXIS WARREN

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	172A00000X	Driver	W65000087945	IL

General Provider Information

NPI Number	:	1609468644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS WARREN

Provider Business Mailing Address
First Line	:	1116 GARFIELD ST UNIT 4293
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-0752
Country	:	US
Telephone Number	:	312-741-1086
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 W WASHINGTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-2418
Country	:	US
Telephone Number	:	312-741-1086
Fax Number	:

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

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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Directions to “ ALEXIS WARREN ” Practice Location

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