MEDICARE: KATHLEEN H MOE 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	174400000X	Specialist	036078007	IL
2	207V00000X	Obstetrics & Gynecology Physician	036078007	IL
3	207Q00000X	Family Medicine Physician	036078007	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	:	1649218397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN H MOE M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE
Second Line	:	STE LL7
City	:	CHICAGO
State	:	IL
Zip	:	60625-3543
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-293-4197

Provider Business Practice Location Address
First Line	:	3414 W PETERSON AVE
Second Line	:	SUITE D
City	:	CHICAGO
State	:	IL
Zip	:	60659-3452
Country	:	US
Telephone Number	:	773-267-0422
Fax Number	:	773-267-0561

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/29/2024

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Directions to “ KATHLEEN H MOE M.D.” Practice Location

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