MEDICARE: LOUIE MOORE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1427804186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIE MOORE

Provider Business Mailing Address
First Line	:	26241 LAKE SHORE BLVD
Second Line	:	STE. 2170
City	:	EUCLID
State	:	OH
Zip	:	44132-1149
Country	:	US
Telephone Number	:	216-387-2023
Fax Number	:

Provider Business Practice Location Address
First Line	:	26241 LAKE SHORE BLVD APT 2170
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1149
Country	:	US
Telephone Number	:	216-387-2023
Fax Number	:

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

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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Directions to “ LOUIE MOORE ” Practice Location

Language	Start Address	Practice Location

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