Provider Demographics
NPI:1013134394
Name:MOSS, BRIAN HARRIS (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HARRIS
Last Name:MOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:415 W GOLF RD
Mailing Address - Street 2:SUITE 68
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3929
Mailing Address - Country:US
Mailing Address - Phone:847-593-5511
Mailing Address - Fax:847-593-0872
Practice Address - Street 1:415 W GOLF RD
Practice Address - Street 2:SUITE 68
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3929
Practice Address - Country:US
Practice Address - Phone:847-593-5511
Practice Address - Fax:847-593-0872
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11514207X00000X
IL036130220207X00000X
MI5101016864207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615125OtherBCBS OF IL