Healthcare Provider Details

I. General information

NPI: 1952389231
Provider Name (Legal Business Name): DAVID MOSES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 MONROE ST STE 100
DEARBORN MI
48124-3057
US

IV. Provider business mailing address

2142 MONROE ST STE 100
DEARBORN MI
48124-3057
US

V. Phone/Fax

Practice location:
  • Phone: 313-481-1030
  • Fax: 313-481-1031
Mailing address:
  • Phone: 313-481-1030
  • Fax: 313-481-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberDM048222
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: