MEDICARE: MICHAEL MOON 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	054221	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0637621	OTHER	MI	BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366488157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MOON MD

Provider Business Mailing Address
First Line	:	PO BOX 80275
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48308-0275
Country	:	US
Telephone Number	:	248-652-5000
Fax Number	:	248-652-5605

Provider Business Practice Location Address
First Line	:	1101 W UNIVERSITY DRIVE
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1831
Country	:	US
Telephone Number	:	248-652-5000
Fax Number	:	248-652-5605

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHAEL MOON MD” Practice Location

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