Provider Demographics
NPI:1316917875
Name:WARNER, ELIZABETH J (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-544-3276
Mailing Address - Fax:269-544-3288
Practice Address - Street 1:5629 STADIUM DR
Practice Address - Street 2:STE B BRONSON INTERNAL MEDICINE OSHTEMO
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1952
Practice Address - Country:US
Practice Address - Phone:269-544-3276
Practice Address - Fax:269-544-3288
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417961137OtherBCBSM - BMH
MICA4396OtherRAILROAD MEDICARE
MI4319769Medicaid
MI1316917875Medicaid
MI1316917875Medicaid
OM20520009Medicare ID - Type Unspecified
MI4319769Medicaid