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NPI Code Detail

MEDICARE: DR. NICHOLE M BUTLER-MOO YOUNG MD

MEDICARE: DR. NICHOLE M BUTLER-MOO YOUNG 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
1207V00000XObstetrics & Gynecology Physician036099421IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245222108
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLE M BUTLER-MOO YOUNG MD
Provider Business Mailing Address
First Line : 7411 LAKE ST STE 1120
Second Line :
City : RIVER FOREST
State : IL
Zip : 60305-1882
Country : US
Telephone Number : 708-763-2328
Fax Number : 708-345-9984
Provider Business Practice Location Address
First Line : 7411 LAKE ST STE 1120
Second Line :
City : RIVER FOREST
State : IL
Zip : 60305-1882
Country : US
Telephone Number : 708-763-2328
Fax Number : 708-345-9984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 12/03/2025

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