Provider Demographics
NPI:1871519124
Name:WARREN, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 W JEFFERSON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5264
Mailing Address - Country:US
Mailing Address - Phone:815-773-9090
Mailing Address - Fax:815-773-9099
Practice Address - Street 1:3077 W JEFFERSON ST STE 210
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5264
Practice Address - Country:US
Practice Address - Phone:815-773-9090
Practice Address - Fax:815-773-9099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104101207R00000X
IL036104101207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104101Medicaid
C58999Medicare UPIN
IL993550Medicare ID - Type Unspecified