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NPI Code Detail

MEDICARE: DORI MOSCOWITZ D.O.

MEDICARE: DORI MOSCOWITZ D.O.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician036147513IL

General Provider Information

NPI Number : 1710349725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORI MOSCOWITZ D.O.
Provider Business Mailing Address
First Line : 181 W MADISON ST
Second Line : STE 3825
City : CHICAGO
State : IL
Zip : 60602-4500
Country : US
Telephone Number : 773-975-1600
Fax Number :
Provider Business Practice Location Address
First Line : 1931 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-5008
Country : US
Telephone Number : 312-998-5510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2016
Last Update Date : 09/03/2019

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Directions to “ DORI MOSCOWITZ D.O.” Practice Location

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