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General NPI Number Information
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NPI Number | 1376877027
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Entity Type | Organization
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Legal Business Name | MARK J. MOSS DPM P.C.
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 29701 6 MILE RD STE 100A
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City | LIVONIA
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State | MI
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Zip | 48152-8601
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Country | US
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Telephone | 734-261-3808
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Fax | 734-261-3821
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Provider Business Mailing Address
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Address Line | 29701 6 MILE RD STE 100A
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City | LIVONIA
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State | MI
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Zip | 48152-8601
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Country | US
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Telephone | 734-261-3808
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Fax | 734-261-3821
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK J MOSS
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Credential | DPM
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Telephone | 734-261-3808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901000715
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License Number State | MI
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