Provider Demographics
NPI:1013189471
Name:PHILIP A MOORE MD INC
Entity Type:Organization
Organization Name:PHILIP A MOORE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-428-8750
Mailing Address - Street 1:1551 BOND ST
Mailing Address - Street 2:STE 127
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0137
Mailing Address - Country:US
Mailing Address - Phone:630-428-8750
Mailing Address - Fax:630-428-8537
Practice Address - Street 1:1551 BOND ST
Practice Address - Street 2:STE 127
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0137
Practice Address - Country:US
Practice Address - Phone:630-428-8750
Practice Address - Fax:630-428-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088408173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216616Medicare PIN