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General NPI Number Information
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NPI Number | 1013189471
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Entity Type | Organization
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Legal Business Name | PHILIP A MOORE MD INC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 1551 BOND ST STE 127
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City | NAPERVILLE
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State | IL
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Zip | 60563-0137
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Country | US
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Telephone | 630-428-8750
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Fax | 630-428-8537
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Provider Business Mailing Address
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Address Line | 1551 BOND ST STE 127
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City | NAPERVILLE
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State | IL
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Zip | 60563-0137
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Country | US
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Telephone | 630-428-8750
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Fax | 630-428-8537
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP A MOORE
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Credential | MD
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Telephone | 630-428-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 036088408
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License Number State | IL
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