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General NPI Number Information
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NPI Number | 1316258205
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Entity Type | Individual
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Provider Name | KRISTIN LEE MOORE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 4755 N KENMORE AVE
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City | CHICAGO
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State | IL
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Zip | 60640-5015
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Country | US
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Telephone | 515-450-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 1367 N HOYNE AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60622-3020
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Country | US
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Telephone | 515-450-2830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 125-058402
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036134628
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License Number State | IL
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