Provider Demographics
NPI:1588197677
Name:MOORE, CHELSEA ROSE (DO)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ROSE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:251 E HURON ST STE 16-738
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3055
Mailing Address - Country:US
Mailing Address - Phone:312-926-5924
Mailing Address - Fax:312-926-6134
Practice Address - Street 1:7000 E BELLEVIEW AVE STE 209
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1622
Practice Address - Country:US
Practice Address - Phone:720-482-3777
Practice Address - Fax:720-482-3776
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036152538208M00000X
CODR.0071744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist