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General NPI Number Information
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NPI Number | 1144497892
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Entity Type | Organization
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Legal Business Name | MICHAEL C. MORAN, M.D., S.C.
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 9830 RIDGELAND AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2667
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Country | US
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Telephone | 708-425-1744
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Fax |
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Provider Business Mailing Address
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Address Line | 9830 RIDGELAND AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2667
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Country | US
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Telephone | 708-425-1744
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. MICHAEL C MORAN
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Credential | M.D., S.C.
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Telephone | 708-425-1744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036084080
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License Number State | IL
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