Provider Demographics
NPI:1801840954
Name:MORENO, LAARNI MAY G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAARNI MAY
Middle Name:G
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAARNI MAY
Other - Middle Name:G
Other - Last Name:PAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2968
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-2968
Mailing Address - Country:US
Mailing Address - Phone:574-296-3200
Mailing Address - Fax:574-296-3921
Practice Address - Street 1:303 S NAPPANEE ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2066
Practice Address - Country:US
Practice Address - Phone:574-296-3200
Practice Address - Fax:574-296-3921
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112099207R00000X
IN01066219A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20090980Medicaid
IN227950E2Medicare PIN