Healthcare Provider Details

I. General information

NPI: 1780670216
Provider Name (Legal Business Name): JOSEPHINE H MO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 IL ROUTE 22 SUITE 2
FOX RIVER GROVE IL
60021-1998
US

IV. Provider business mailing address

1550 N NORTHWEST HWY SUITE 220
PARK RIDGE IL
60068-1411
US

V. Phone/Fax

Practice location:
  • Phone: 847-842-9366
  • Fax: 847-842-9467
Mailing address:
  • Phone: 847-298-7024
  • Fax: 847-298-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036106515
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: