MEDICARE: SUSAN L WARNER M.D.

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	207V00000X	Obstetrics & Gynecology Physician	036065326	IL

General Provider Information

NPI Number	:	1801888383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L WARNER M.D.

Provider Business Mailing Address
First Line	:	2801 LAKESIDE DR STE 209
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1271
Country	:	US
Telephone Number	:	847-562-1410
Fax Number	:	847-562-0830

Provider Business Practice Location Address
First Line	:	1000 CENTRAL ST STE 717
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1779
Country	:	US
Telephone Number	:	847-864-1200
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	01/16/2020

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