Healthcare Provider Details

I. General information

NPI: 1174633168
Provider Name (Legal Business Name): JANET MOY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E.US-6 FRONTAGE ROAD
VALPARAISO IN
46383
US

IV. Provider business mailing address

3411 W LAKESHORE DR
CROWN POINT IN
46307-8922
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-8300
  • Fax:
Mailing address:
  • Phone: 630-532-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02001714A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036088686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: