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General NPI Number Information
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NPI Number | 1245727403
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Entity Type | Organization
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Legal Business Name | CARL K. MOSHOVITIS, M.D., S.C.
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 7126 N LINCOLN AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2234
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Country | US
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Telephone | 847-864-6666
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Fax | 847-864-0088
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Provider Business Mailing Address
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Address Line | PO BOX 2876
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City | GLENVIEW
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State | IL
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Zip | 60025-6876
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Country | US
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Telephone | 847-864-6666
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Fax | 847-864-0088
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL K MOSHOVITIS
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Credential | MD
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Telephone | 847-708-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036077963
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036077963
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036077963
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License Number State | IL
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