Healthcare Provider Details

I. General information

NPI: 1356832273
Provider Name (Legal Business Name): DARCIE DENISE MOELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W HARRISON ST
CHICAGO IL
60612-3741
US

IV. Provider business mailing address

7556 JACKSON BLVD
FOREST PARK IL
60130-1854
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-4500
  • Fax:
Mailing address:
  • Phone: 708-836-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number036-156409
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036156409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: