Provider Demographics
NPI:1972035640
Name:MOORE, SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPT. OF ANESTHESIOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1057
Mailing Address - Country:US
Mailing Address - Phone:847-570-2760
Mailing Address - Fax:847-570-2921
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPT. OF ANESTHESIOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1057
Practice Address - Country:US
Practice Address - Phone:847-570-2760
Practice Address - Fax:847-570-2921
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036160629207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine