MEDICARE: DR. DAVID MOSS 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	207P00000X	Emergency Medicine Physician	22254-020	WI

General Provider Information

NPI Number	:	1669615670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MOSS M.D.

Provider Business Mailing Address
First Line	:	5770 N SHORE DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4864
Country	:	US
Telephone Number	:	414-964-6080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5770 N SHORE DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4864
Country	:	US
Telephone Number	:	414-964-6080
Fax Number	:

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

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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Directions to “ DR. DAVID MOSS M.D.” Practice Location

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