Provider Demographics
NPI:1093797136
Name:MOELLER, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:MOELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:37000 WOODWARD AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0922
Mailing Address - Country:US
Mailing Address - Phone:248-952-9200
Mailing Address - Fax:248-952-9201
Practice Address - Street 1:6040 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2421
Practice Address - Country:US
Practice Address - Phone:304-293-1020
Practice Address - Fax:304-293-7042
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2024-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV33178207QS0010X
MIJM063478207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N12610Medicare PIN
MIF56260Medicare UPIN