Provider Demographics
NPI:1053491639
Name:DENNIS M MOORE MD SC
Entity Type:Organization
Organization Name:DENNIS M MOORE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:847-518-1200
Mailing Address - Street 1:1875 DEMPSTER
Mailing Address - Street 2:SUITE 625
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-518-1200
Mailing Address - Fax:847-518-1209
Practice Address - Street 1:1875 DEMPSTER
Practice Address - Street 2:SUITE 625
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-518-1200
Practice Address - Fax:847-518-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S51190Medicare ID - Type Unspecified
E03960Medicare UPIN