Healthcare Provider Details

I. General information

NPI: 1316072366
Provider Name (Legal Business Name): JAMES MICHAEL MORIARITY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 MOREAU DRIVE
NOTRE DAME IN
46556
US

IV. Provider business mailing address

16169 WATERSIDE DR
GRANGER IN
46530-8394
US

V. Phone/Fax

Practice location:
  • Phone: 574-631-5471
  • Fax: 574-631-1599
Mailing address:
  • Phone: 574-532-0304
  • Fax: 574-631-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number01036239B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: