Basic Information
| Provider Information | |||||||||
| NPI: | 1316917875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 JOHN ST | ||||||||
| Address2: | BOX 42 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695443276 | ||||||||
| FaxNumber: | 2695443288 | ||||||||
| Practice Location | |||||||||
| Address1: | 5629 STADIUM DR | ||||||||
| Address2: | STE B BRONSON INTERNAL MEDICINE OSHTEMO | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490091952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695443276 | ||||||||
| FaxNumber: | 2695443288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301071879 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1417961137 | 01 | MI | BCBSM - BMH | OTHER | CA4396 | 01 | MI | RAILROAD MEDICARE | OTHER | 4319769 | 05 | MI | MEDICAID | 1316917875 | 05 | MI | MEDICAID |