Healthcare Provider Details

I. General information

NPI: 1013189471
Provider Name (Legal Business Name): PHILIP A MOORE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BOND ST STE 127
NAPERVILLE IL
60563-0137
US

IV. Provider business mailing address

1551 BOND ST STE 127
NAPERVILLE IL
60563-0137
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-8750
  • Fax: 630-428-8537
Mailing address:
  • Phone: 630-428-8750
  • Fax: 630-428-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036088408
License Number StateIL

VIII. Authorized Official

Name: PHILIP A MOORE
Title or Position: PRESIDENT
Credential: MD
Phone: 630-428-8750