Healthcare Provider Details

I. General information

NPI: 1710951470
Provider Name (Legal Business Name): MICHAEL MORITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

3414 5TH AVE CHOB BUILDING, 1ST FLOOR
PITTSBURGH PA
15213-3205
US

V. Phone/Fax

Practice location:
  • Phone: 303-763-3323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.151907
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD069182L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35.151907
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: