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General NPI Number Information
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NPI Number | 1902880354
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Entity Type | Individual
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Provider Name | MICHELLE THERESA MORAN MD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 213 N HURSTBOURNE PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-5139
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Country | US
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Telephone | 502-327-5135
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Fax | 502-327-9475
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36769
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License Number State | KY
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