Provider Demographics
NPI:1588799522
Name:MOORE ASSOCIATES IN WOMENS HEALTH
Entity Type:Organization
Organization Name:MOORE ASSOCIATES IN WOMENS HEALTH
Other - Org Name:MONICA A. MOORE MD CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-212-9000
Mailing Address - Street 1:4852 S CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3066
Mailing Address - Country:US
Mailing Address - Phone:312-212-9000
Mailing Address - Fax:312-212-9003
Practice Address - Street 1:41 E 8TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2168
Practice Address - Country:US
Practice Address - Phone:312-212-9000
Practice Address - Fax:312-212-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096183207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1912914490OtherNPI #
IL36-4454907OtherMONICA MOORE MD CORP
IL036096183Medicaid
IL997080Medicare ID - Type Unspecified