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NPI Code Detail

MEDICARE: DR. ILENE RUBOWITZ MOORE MD

MEDICARE: DR. ILENE RUBOWITZ 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
1208000000XPediatrics Physician45291MN

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 : 1659331445
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ILENE RUBOWITZ MOORE MD
Provider Business Mailing Address
First Line : 14001 RIDGEDALE DR
Second Line :
City : MINNETONKA
State : MN
Zip : 55305-1753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14001 RIDGEDALE DR STE 100
Second Line :
City : HOPKINS
State : MN
Zip : 55305-1781
Country : US
Telephone Number : 952-473-0211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 01/12/2024

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Directions to “ DR. ILENE RUBOWITZ MOORE MD” Practice Location

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