MEDICARE: MOSES KYOBE MD FACC

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	207UN0901X	Nuclear Cardiology Physician	036-145828	IL
2	207RC0000X	Cardiovascular Disease Physician	036-145828	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1386634384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOSES KYOBE MD FACC

Provider Business Mailing Address
First Line	:	PO BOX 78866
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53278-8866
Country	:	US
Telephone Number	:	779-696-7150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 CHARLES ST STE 300
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61104-2200
Country	:	US
Telephone Number	:	779-696-5888
Fax Number	:	779-696-5898

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	04/09/2021

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Directions to “ MOSES KYOBE MD FACC” Practice Location

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