MEDICARE: JOHN P MORAN M.D.

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
1	207RG0100X	Gastroenterology Physician	036084151	IL

General Provider Information

NPI Number	:	1225036056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P MORAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3223
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60011-3223
Country	:	US
Telephone Number	:	847-372-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 W ARMY TRAIL RD
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1901
Country	:	US
Telephone Number	:	630-629-5100
Fax Number	:	630-629-5104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/28/2012

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