Provider Demographics
NPI:1992770580
Name:FOURNIER, WARREN J II (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:J
Last Name:FOURNIER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 N RUBY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1926
Mailing Address - Country:US
Mailing Address - Phone:618-398-4226
Mailing Address - Fax:618-398-1759
Practice Address - Street 1:125 N RUBY LN
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1926
Practice Address - Country:US
Practice Address - Phone:618-398-4226
Practice Address - Fax:618-398-1759
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361150992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I48418Medicare UPIN