Healthcare Provider Details

I. General information

NPI: 1932801917
Provider Name (Legal Business Name): ERIKA MICHELLE MOXLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE BUILDING 105, ROOM 1870
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE BUILDING 105, ROOM 1870
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-1676
  • Fax:
Mailing address:
  • Phone: 708-216-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125.081712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: