Provider Demographics
NPI:1679912406
Name:MOONEY, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:965 EMERSON PKWY STE J
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6274
Practice Address - Country:US
Practice Address - Phone:317-887-1060
Practice Address - Fax:317-887-1460
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2023-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01076382A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201173910Medicaid