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NPI Code Detail

MEDICARE: DR. JAMES L MOELLER MD

MEDICARE: DR. JAMES L MOELLER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QS0010XSports Medicine (Family Medicine) Physician33178WV
2207QS0010XSports Medicine (Family Medicine) PhysicianJM063478MI

General Provider Information

NPI Number : 1093797136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES L MOELLER MD
Provider Business Mailing Address
First Line : 37000 WOODWARD AVE
Second Line : STE 300
City : BLOOMFIELD HILLS
State : MI
Zip : 48304-0922
Country : US
Telephone Number : 248-952-9200
Fax Number : 248-952-9201
Provider Business Practice Location Address
First Line : 6040 UNIVERSITY TOWN CENTRE DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26501-2421
Country : US
Telephone Number : 304-293-1020
Fax Number : 304-293-7042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 02/09/2024

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