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NPI Code Detail

MEDICARE: JOHN CHRISTOPHER MORAN LMSW

MEDICARE: JOHN CHRISTOPHER MORAN LMSW
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
11041C0700XClinical Social Worker6801065151MI

General Provider Information

NPI Number : 1659410041
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN CHRISTOPHER MORAN LMSW
Provider Business Mailing Address
First Line : 402 N 1ST AVE
Second Line :
City : TAWAS CITY
State : MI
Zip : 48763-9395
Country : US
Telephone Number : 989-362-8636
Fax Number :
Provider Business Practice Location Address
First Line : 1199 HARRIS AVE
Second Line :
City : TAWAS CITY
State : MI
Zip : 48763-9681
Country : US
Telephone Number : 989-362-8636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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