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NPI Code Detail

MEDICARE: POLLY ANNE MOORE MD

MEDICARE: POLLY ANNE MOORE MD
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
1207RA0001XAdvanced Heart Failure and Transplant Cardiology Physician01057207AIN
2207RC0000XCardiovascular Disease Physician01057207AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356325369
Entity Type Code : Individual
Provider Name (Legal Business Name) : POLLY ANNE MOORE MD
Provider Business Mailing Address
First Line : PO BOX 781076
Second Line :
City : DETROIT
State : MI
Zip : 48278-1076
Country : US
Telephone Number : 317-528-4800
Fax Number : 317-865-1479
Provider Business Practice Location Address
First Line : 5330 E STOP 11 RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-6345
Country : US
Telephone Number : 317-893-1900
Fax Number : 317-893-1901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 07/28/2023

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Directions to “ POLLY ANNE MOORE MD” Practice Location

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